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Newman JD, O'Meara E, Böhm M, Savarese G, Kelly PR, Vardeny O, Allen LA, Lancellotti P, Gottlieb SS, Samad Z, Morris AA, Desai NR, Rosano GMC, Teerlink JR, Giraldo CS, Lindenfeld J. Implications of Atrial Fibrillation for Guideline-Directed Therapy in Patients With Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:932-950. [PMID: 38418008 DOI: 10.1016/j.jacc.2023.12.033] [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: 09/18/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 03/01/2024]
Abstract
Atrial fibrillation (AF) and heart failure (HF) are common cardiovascular conditions that frequently coexist. Among patients with HF, more than one-half also have AF. Both are associated with significant morbidity and mortality. Moreover, the prevalence of each is increasing globally, and this trend is expected to continue owing to an aging population and increased life expectancy. Diagnosis of AF in a patient with HF is associated with greater symptom burden, more frequent hospitalizations, and a worse prognosis. Guideline-directed medical therapy (GDMT) for HF can affect the incidence of AF. Once present, AF can influence the efficacy of some components of GDMT for HF. In this review, we discuss the effect of GDMT for HF across the spectrum of ejection fraction on prevention of AF as well as the benefit of GDMT in patients with vs without AF.
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Affiliation(s)
| | - Eileen O'Meara
- Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Michael Böhm
- University of the Saarland, Homberg/Saar, Germany
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Orly Vardeny
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Stephen S Gottlieb
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA; Baltimore Veterans Administration Medical Center, Baltimore, Maryland, USA
| | | | | | - Nihar R Desai
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Giuseppe M C Rosano
- Center for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | | | | | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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2
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Hofmeyer M, Haas GJ, Jordan E, Cao J, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Huggins GS, Kinnamon DD, Ni H, Hershberger RE. Rare Variant Genetics and Dilated Cardiomyopathy Severity: The DCM Precision Medicine Study. Circulation 2023; 148:872-881. [PMID: 37641966 PMCID: PMC10530109 DOI: 10.1161/circulationaha.123.064847] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) can lead to advanced disease, defined herein as necessitating a durable left ventricular assist device or a heart transplant (LVAD/HT). DCM is known to have a genetic basis, but the association of rare variant genetics with advanced DCM has not been studied. METHODS We analyzed clinical and genetic sequence data from patients enrolled between 2016 and 2021 in the US multisite DCM Precision Medicine Study, which was a geographically diverse, multiracial, multiethnic cohort. Clinical evaluation included standardized patient interview and medical record query forms. DCM severity was classified into 3 groups: patients with advanced disease with LVAD/HT; patients with an implantable cardioverter defibrillator (ICD) only; or patients with no ICD or LVAD/HT. Rare variants in 36 DCM genes were classified as pathogenic or likely pathogenic or variants of uncertain significance. Confounding factors we considered included demographic characteristics, lifestyle factors, access to care, DCM duration, and comorbidities. Crude and adjusted associations between DCM severity and rare variant genetic findings were assessed using multinomial models with generalized logit link. RESULTS Patients' mean (SD) age was 51.9 (13.6) years; 42% were of African ancestry, 56% were of European ancestry, and 44% were female. Of 1198 patients, 347 had LVAD/HT, 511 had an ICD, and 340 had no LVAD/HT or ICD. The percentage of patients with pathogenic or likely pathogenic variants was 26.2%, 15.9%, and 15.0% for those with LVAD/HT, ICD only, or neither, respectively. After controlling for sociodemographic characteristics and comorbidities, patients with DCM with LVAD/HT were more likely than those without LVAD/HT or ICD to have DCM-related pathogenic or likely pathogenic rare variants (odds ratio, 2.3 [95% CI, 1.5-3.6]). The association did not differ by ancestry. Rare variant genetic findings were similar between patients with DCM with an ICD and those without LVAD/HT or ICD. CONCLUSIONS Advanced DCM was associated with higher odds of rare variants in DCM genes adjudicated as pathogenic or likely pathogenic, compared with individuals with less severe DCM. This finding may help assess the risk of outcomes in management of patients with DCM and their at-risk family members. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03037632.
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Affiliation(s)
- Mark Hofmeyer
- MedStar Health Research Institute, Medstar Washington Hospital Center, Washington, DC
| | - Garrie J. Haas
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Elizabeth Jordan
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Jinwen Cao
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha, NE
| | | | - W. H. Wilson Tang
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J.C. Walter Jr. Transplant Center, Houston TX
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, VA
| | - Salpy V. Pamboukian
- University of Alabama, Birmingham, AL during study conduct, current affiliation, University of Washington, Seattle, WA
| | - Nancy K. Sweitzer
- Sarver Heart Center, University of Arizona, Tucson, AZ during study conduct, current affiliation, Washington University, St. Louis, MO
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stuart Katz
- New York University Langone Medical Center, New York, NY
| | - Stephen Pan
- New York University Langone Medical Center, New York, NY
- current affiliation, Department of Cardiology, Westchester Medical Center & New York Medical College, Valhalla, NY
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, FL
| | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles, CA
| | | | | | | | - Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - Daniel D. Kinnamon
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Hanyu Ni
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Ray E. Hershberger
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
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Gottlieb ER, Gottlieb SS. A Retrospective Cohort Study of the Association of Inpatient Amlodipine Dose With Renal Complication Rates and Hospital Length of Stay. Cureus 2023; 15:e46237. [PMID: 37908905 PMCID: PMC10613586 DOI: 10.7759/cureus.46237] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Background Correct hospital medication reconciliation is important for continuity of care, but optimal home antihypertensive medication ordering has not been adequately studied. Since excessive hospital blood pressure control is associated with adverse renal and cardiovascular outcomes, we assessed the association of inpatient doses of amlodipine (10mg vs. 5mg) with length of stay and renal failure and fluid and electrolyte disorders (RF/FED). Methods In this retrospective cohort study, clinical and demographic data on patients not initially admitted to the ICU between 2008 and 2019 were extracted from the Medical Information Mart for Intensive Care (MIMIC-IV). Multivariable logistic regression was used to assess the association between amlodipine dose during the first 24 hours of admission and RF/FED. Multivariable linear regression was used to assess the association between amlodipine dose and length of stay when controlling for RF/FED or maximum blood urea nitrogen (BUN) concentration and other confounders. Results There were 5,932 patients included in this study, and 3,038 of whom received 10mg of amlodipine. A 10mg dose of amlodipine was associated with an increased likelihood of RF/FED (OR: 1.248, 95% CI (1.104, 1.412), p<0.001). It was also associated with a longer length of stay (coef.: 0.338, 95% CI (0.067, 0.609), p=0.015). This was not significant when controlling for RF/FED (dose coef.: 0.197, 95% CI (-0.070, 0.464), p=0.147) or maximum BUN (dose coef.: 0.082, 95% CI (-0.147, 0.312), p=0.482). Interpretation Higher amlodipine dose was associated with longer length of stay, and this is likely mediated by RF/FED. Randomized trials are needed to determine which home blood pressure medications should be ordered in the hospital.
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Affiliation(s)
- Eric R Gottlieb
- Hospital Medicine, Mount Auburn Hospital, Cambridge, USA
- Medicine, Harvard Medical School, Boston, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, USA
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Jordan E, Kinnamon DD, Haas GJ, Hofmeyer M, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Fishbein DP, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Mead JO, Hurst N, Cao J, Huggins GS, Cowan J, Ni H, Rehm HL, Jarvik GP, Vatta M, Burke W, Hershberger RE. Genetic Architecture of Dilated Cardiomyopathy in Individuals of African and European Ancestry. JAMA 2023; 330:432-441. [PMID: 37526719 PMCID: PMC10394581 DOI: 10.1001/jama.2023.11970] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/13/2023] [Indexed: 08/02/2023]
Abstract
Importance Black patients with dilated cardiomyopathy (DCM) have increased familial risk and worse outcomes than White patients, but most DCM genetic data are from White patients. Objective To compare the rare variant genetic architecture of DCM by genomic ancestry within a diverse population of patients with DCM. Design Cross-sectional study enrolling patients with DCM who self-identified as non-Hispanic Black, Hispanic, or non-Hispanic White from June 7, 2016, to March 15, 2020, at 25 US advanced heart failure programs. Variants in 36 DCM genes were adjudicated as pathogenic, likely pathogenic, or of uncertain significance. Exposure Presence of DCM. Main Outcomes and Measures Variants in DCM genes classified as pathogenic/likely pathogenic/uncertain significance and clinically actionable (pathogenic/likely pathogenic). Results A total of 505, 667, and 26 patients with DCM of predominantly African, European, or Native American genomic ancestry, respectively, were included. Compared with patients of European ancestry, a lower percentage of patients of African ancestry had clinically actionable variants (8.2% [95% CI, 5.2%-11.1%] vs 25.5% [95% CI, 21.3%-29.6%]), reflecting the lower odds of a clinically actionable variant for those with any pathogenic variant/likely pathogenic variant/variant of uncertain significance (odds ratio, 0.25 [95% CI, 0.17-0.37]). On average, patients of African ancestry had fewer clinically actionable variants in TTN (difference, -0.09 [95% CI, -0.14 to -0.05]) and other genes with predicted loss of function as a disease-causing mechanism (difference, -0.06 [95% CI, -0.11 to -0.02]). However, the number of pathogenic variants/likely pathogenic variants/variants of uncertain significance was more comparable between ancestry groups (difference, -0.07 [95% CI, -0.22 to 0.09]) due to a larger number of non-TTN non-predicted loss of function variants of uncertain significance, mostly missense, in patients of African ancestry (difference, 0.15 [95% CI, 0.00-0.30]). Published clinical case-based evidence supporting pathogenicity was less available for variants found only in patients of African ancestry (P < .001). Conclusion and Relevance Patients of African ancestry with DCM were less likely to have clinically actionable variants in DCM genes than those of European ancestry due to differences in genetic architecture and a lack of representation of African ancestry in clinical data sets.
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Affiliation(s)
- Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Garrie J. Haas
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
| | - Mark Hofmeyer
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, DC
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha
| | | | | | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J. C. Walter Jr Transplant Center, Houston, Texas
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Nancy K. Sweitzer
- Sarver Heart Center, University of Arizona, Tucson
- Now with Washington University, St Louis, Missouri
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stuart Katz
- New York University Langone Medical Center, New York, New York
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla
| | - Javier Jimenez
- Miami Cardiac and Vascular Institute, Baptist Health South, Miami, Florida
| | | | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles
| | | | | | | | - Jonathan O. Mead
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Natalie Hurst
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Jinwen Cao
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Jason Cowan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Heidi L. Rehm
- Center for Genomic Medicine, Massachusetts General Hospital, Boston
| | - Gail P. Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle
- Department of Genome Sciences, University of Washington, Seattle
| | - Matteo Vatta
- Departments of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
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5
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Ni H, Jordan E, Kinnamon DD, Cao J, Haas GJ, Hofmeyer M, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Fishbein DP, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Huggins GS, Hershberger RE. Screening for Dilated Cardiomyopathy in At-Risk First-Degree Relatives. J Am Coll Cardiol 2023; 81:2059-2071. [PMID: 37225358 PMCID: PMC10563038 DOI: 10.1016/j.jacc.2023.03.419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/20/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Cardiovascular screening is recommended for first-degree relatives (FDRs) of patients with dilated cardiomyopathy (DCM), but the yield of FDR screening is uncertain for DCM patients without known familial DCM, for non-White FDRs, or for DCM partial phenotypes of left ventricular enlargement (LVE) or left ventricular systolic dysfunction (LVSD). OBJECTIVES This study examined the yield of clinical screening among reportedly unaffected FDRs of DCM patients. METHODS Adult FDRs of DCM patients at 25 sites completed screening echocardiograms and ECGs. Mixed models accounting for site heterogeneity and intrafamilial correlation were used to compare screen-based percentages of DCM, LVSD, or LVE by FDR demographics, cardiovascular risk factors, and proband genetics results. RESULTS A total of 1,365 FDRs were included, with a mean age of 44.8 ± 16.9 years, 27.5% non-Hispanic Black, 9.8% Hispanic, and 61.7% women. Among screened FDRs, 14.1% had new diagnoses of DCM (2.1%), LVSD (3.6%), or LVE (8.4%). The percentage of FDRs with new diagnoses was higher for those aged 45 to 64 years than 18 to 44 years. The age-adjusted percentage of any finding was higher among FDRs with hypertension and obesity but did not differ statistically by race and ethnicity (16.2% for Hispanic, 15.2% for non-Hispanic Black, and 13.1% for non-Hispanic White) or sex (14.6% for women and 12.8% for men). FDRs whose probands carried clinically reportable variants were more likely to be identified with DCM. CONCLUSIONS Cardiovascular screening identified new DCM-related findings among 1 in 7 reportedly unaffected FDRs regardless of race and ethnicity, underscoring the value of clinical screening in all FDRs.
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Affiliation(s)
- Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA; The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA; The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Daniel D Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA; The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Jinwen Cao
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA; The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Garrie J Haas
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA; Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Mark Hofmeyer
- Medstar Research Institute, Washington Hospital Center, Washington, DC, USA
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Barry H Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J.C. Walter Jr Transplant Center, Houston Texas, USA
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | | | - Nancy K Sweitzer
- Sarver Heart Center, University of Arizona, Tucson, Arizona, USA (current address Division of Cardiology, Washington University, St Louis, Missouri, USA)
| | - Matthew T Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jane E Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stuart Katz
- New York University Langone Medical Center, New York, New York, USA
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Javier Jimenez
- Miami Cardiac and Vascular Institute, Baptist Health South, Miami, Florida, USA
| | | | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles, California, USA
| | | | - Daniel P Judge
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Charles K Moore
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Gordon S Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ray E Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA; The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA; Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA.
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6
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Kinnamon DD, Jordan E, Haas GJ, Hofmeyer M, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Aaronson KD, Fishbein DP, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Mead JO, Huggins GS, Ni H, Burke W, Hershberger RE. Effectiveness of the Family Heart Talk Communication Tool in Improving Family Member Screening for Dilated Cardiomyopathy: Results of a Randomized Trial. Circulation 2023; 147:1281-1290. [PMID: 36938756 PMCID: PMC10133091 DOI: 10.1161/circulationaha.122.062507] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/15/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Managing disease risk among first-degree relatives of probands diagnosed with a heritable disease is central to precision medicine. A critical component is often clinical screening, which is particularly important for conditions like dilated cardiomyopathy (DCM) that remain asymptomatic until severe disease develops. Nonetheless, probands are frequently ill-equipped to disseminate genetic risk information that motivates at-risk relatives to complete recommended clinical screening. An easily implemented remedy for this key issue has been elusive. METHODS The DCM Precision Medicine Study developed Family Heart Talk, a booklet designed to help probands with DCM communicate genetic risk and the need for cardiovascular screening to their relatives. The effectiveness of the Family Heart Talk booklet in increasing cardiovascular clinical screening uptake among first-degree relatives was assessed in a multicenter, open-label, cluster-randomized, controlled trial. The primary outcome measured in eligible first-degree relatives was completion of screening initiated within 12 months after proband enrollment. Because probands randomized to the intervention received the booklet at the enrollment visit, eligible first-degree relatives were limited to those who were alive the day after proband enrollment and not enrolled on the same day as the proband. RESULTS Between June 2016 and March 2020, 1241 probands were randomized (1:1) to receive Family Heart Talk (n=621) or not (n=620) within strata defined by site and self-identified race/ethnicity (non-Hispanic Black, non-Hispanic White, or Hispanic). Final analyses included 550 families (n=2230 eligible first-degree relatives) in the Family Heart Talk arm and 561 (n=2416) in the control arm. A higher percentage of eligible first-degree relatives completed screening in the Family Heart Talk arm (19.5% versus 16.0%), and the odds of screening completion among these first-degree relatives were higher in the Family Heart Talk arm after adjustment for proband randomization stratum, sex, and age quartile (odds ratio, 1.30 [1-sided 95% CI, 1.08-∞]). A prespecified subgroup analysis did not find evidence of heterogeneity in the adjusted intervention odds ratio across race/ethnicity strata (P=0.90). CONCLUSIONS Family Heart Talk, a booklet that can be provided to patients with DCM by clinicians with minimal additional time investment, was effective in increasing cardiovascular clinical screening among first-degree relatives of these patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03037632.
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Affiliation(s)
- Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Garrie J. Haas
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Mark Hofmeyer
- Medstar Research Institute, Washington Hospital Center, Washington, DC
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha, NE
| | | | - W. H. Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J.C. Walter Jr. Transplant Center, Houston TX
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, VA
| | - Salpy V. Pamboukian
- University of Alabama, Birmingham, AL; current address, University of Washington, Seattle, WA
| | - Nancy K. Sweitzer
- Sarver Heart Center, University of Arizona, Tucson, AZ; current address, Division of Cardiology, Washington University, St. Louis, MO
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stuart Katz
- New York University Langone Medical Center, New York, NY
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center & New York Medical College, Valhalla, NY
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, FL
| | | | | | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles, CA
| | | | | | | | - Jonathan O. Mead
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, WA
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
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7
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Savarese G, Lindenfeld J, Stolfo D, Adams K, Ahmad T, Desai NR, Ammirati E, Gottlieb SS, Psotka MA, Rosano GMC, Allen LA. Use of patient-reported outcomes in heart failure: from clinical trials to routine practice. Eur J Heart Fail 2023; 25:139-151. [PMID: 36644876 DOI: 10.1002/ejhf.2778] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 08/25/2022] [Revised: 12/06/2022] [Accepted: 01/08/2023] [Indexed: 01/17/2023] Open
Abstract
Heart failure (HF) is a complex syndrome that affects mortality/morbidity and acts at different levels in the patient's life, resulting in a drastic impairment in multiple aspects of daily activities (e.g. physical, mental/emotional, and social) and leading to a reduction in quality of life. The definition of disease status and symptom severity has been traditionally based on the physician assessment, while the patient's experience of disease has been long overlooked. The active participation of patients in their own care is necessary to better understand the perception of disease and the multiple aspects of life affected, and to improve adherence to treatments. Patient-reported outcomes (PROs) aim to switch traditional care to a more patient-centred approach. Although PROs demonstrated precision in the evaluation of disease status and have a good association with prognosis in several randomized controlled trials, their implementation into clinical practice is limited. This review discusses the modalities of use of PROs in HF, summarizes the most largely adopted PROs in HF care, and provides an overview on the application of PROs in trials and the potential for their transition to clinical practice. By discussing the advantages and the disadvantages of their use, the reasons limiting their application in daily clinical routine, and the strategies that may promote their implementation, this review aims to foster the systematic integration of the patient's standpoint in HF care.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joann Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Davide Stolfo
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Kirkwood Adams
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tariq Ahmad
- Yale School of Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA
| | - Nihar R Desai
- Yale School of Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA
| | - Enrico Ammirati
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stephen S Gottlieb
- Division of Cardiovascular Medicine, University of Maryland School of Medicine and Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
| | | | - Giuseppe M C Rosano
- Centre for Clinical & Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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8
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Ni H, Jordan E, Cao J, Kinnamon DD, Gottlieb SS, Hofmeyer M, Jimenez J, Judge DP, Kransdorf E, Morris AA, Owens A, Shah P, Tang WHW, Wang J, Hershberger RE. Knowledge of Genome Sequencing and Trust in Medical Researchers Among Patients of Different Racial and Ethnic Groups With Idiopathic Dilated Cardiomyopathy. JAMA Cardiol 2023; 8:33-42. [PMID: 36383367 PMCID: PMC9669924 DOI: 10.1001/jamacardio.2022.4132] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022]
Abstract
Importance Cardiovascular disease contributes outsized mortality in patients from underrepresented racial and ethnic groups. Understanding levels of trust in medical researchers and knowledge of genome sequencing may help identify barriers to research participation and develop strategies to educate patients about the role of genetics in cardiovascular disease. Objective To assess racial and ethnic differences in trust in medical researchers and genome-sequencing knowledge among patients with idiopathic dilated cardiomyopathy and determine the association between trust in medical researchers and genome-sequencing knowledge. Design, Setting, and Participants This cross-sectional study conducted by a consortium of 25 US heart failure programs included patients with idiopathic dilated cardiomyopathy defined as left ventricular systolic dysfunction and left ventricular enlargement after excluding usual clinical causes. Enrollment occurred from June 7, 2016, to March 15, 2020. Main Outcomes and Measures Percent distributions, means, and associations of genome-sequencing knowledge scores and research trust scores for Hispanic, non-Hispanic Black (hereafter referred to as Black), and non-Hispanic White participants (hereafter referred to as White). Results Among 1121 participants, mean (SD) age was 51.6 (13.6) years with 41.4% Black, 8.5% Hispanic, and 43.4% female. After accounting for site effects, the level of genome-sequencing knowledge was lower in Hispanic and Black participants compared with White participants (mean score difference, -2.6; 95% CI, -3.9 to -1.2 and mean score difference, -2.9; 95% CI, -3.6 to -2.2, respectively). The level of trust in researchers was lowest in Black participants (mean score, 27.7), followed by Hispanic participants (mean score, 29.4) and White participants (mean score, 33.9). Racial and ethnic differences remained after adjusting for education, age at enrollment, duration of dilated cardiomyopathy, and health status. A higher level of trust was associated with a higher level of genome-sequencing knowledge within different racial and ethnic groups. Conclusions and Relevance In this cross-sectional study, large racial and ethnic differences in levels of genome-sequencing knowledge and trust in medical researchers were observed among patients with dilated cardiomyopathy. Findings from this study can inform future studies that aim to enhance the uptake of genomic knowledge and level of trust in medical researchers.
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Affiliation(s)
- Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Jinwen Cao
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | | | - Mark Hofmeyer
- Medstar Research Institute, Washington Hospital Center, Washington, DC
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, Florida
| | | | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
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9
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Elliott P, Drachman BM, Gottlieb SS, Hoffman JE, Hummel SL, Lenihan DJ, Ebede B, Gundapaneni B, Li B, Sultan MB, Shah SJ. Long-term survival in people with transthyretin amyloid cardiomyopathy who took tafamidis: A Plain Language Summary. Future Cardiol 2023; 19:7-17. [PMID: 36715498 DOI: 10.2217/fca-2022-0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
WHAT IS THIS PLAIN LANGUAGE SUMMARY ABOUT? This summary presents the results from an ongoing, long-term extension study that followed an earlier study called ATTR-ACT. People who took part in this extension study and ATTR-ACT have a type of heart disease known as transthyretin amyloid cardiomyopathy (ATTR-CM for short), which causes heart failure and death. In ATTR-ACT, people took either a medicine called tafamidis or a placebo (a pill that looks like the study drug but does not contain any active ingredients) for up to 2½ years. So far, in the long-term extension study, people have continued taking tafamidis, or switched from taking a placebo to tafamidis, for another 2½ years. Researchers looked at how many people died in ATTR-ACT and the extension study. The long-term extension study is expected to end in 2027, so these are interim (not final) results. WHAT DID RESEARCHERS FIND OUT? In the extension study of ATTR-ACT, the risk of dying was lower in people who took tafamidis continuously throughout ATTR-ACT and the extension study than in people who took placebo in ATTR-ACT and switched to tafamidis in the extension study. WHAT DO THE RESULTS MEAN? Taking tafamidis increases how long people with ATTR-CM live. People with ATTR-CM who take tafamidis early and continuously are more likely to live longer than those who do not. These results highlight the importance of early detection and treatment in people with ATTR-CM. Clinical Trial Registration: NCT01994889 (ClinicalTrials.gov) Clinical Trial Registration: NCT02791230 (ClinicalTrials.gov).
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Affiliation(s)
| | | | | | | | - Scott L Hummel
- University of Michigan & Ann Arbor Veterans Affairs Health System, Ann Arbor, MI, USA
| | | | | | | | | | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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10
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Blaustein MP, Gottlieb SS, Hamlyn JM, Leenen FHH. Whither digitalis? What we can still learn from cardiotonic steroids about heart failure and hypertension. Am J Physiol Heart Circ Physiol 2022; 323:H1281-H1295. [PMID: 36367691 DOI: 10.1152/ajpheart.00362.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 11/13/2022]
Abstract
Cloning of the "Na+ pump" (Na+,K+-ATPase or NKA) and identification of a circulating ligand, endogenous ouabain (EO), a cardiotonic steroid (CTS), triggered seminal discoveries regarding EO and its NKA receptor in cardiovascular function and the pathophysiology of heart failure (HF) and hypertension. Cardiotonic digitalis preparations were a preferred treatment for HF for two centuries, but digoxin was only marginally effective in a large clinical trial (1997). This led to diminished digoxin use. Missing from the trial, however, was any consideration that endogenous CTS might influence digitalis' efficacy. Digoxin, at therapeutic concentrations, acutely inhibits NKA but, remarkably, antagonizes ouabain's action. Prolonged treatment with ouabain, but not digoxin, causes hypertension in rodents; in this model, digoxin lowers blood pressure (BP). Furthermore, NKA-bound ouabain and digoxin modulate different protein kinase signaling pathways and have disparate long-term cardiovascular effects. Reports of "brain ouabain" led to the elucidation of a new, slow neuromodulatory pathway in the brain; locally generated EO and the α2 NKA isoform help regulate sympathetic drive to the heart and vasculature. The roles of EO and α2 NKA have been studied by EO assay, ouabain-resistant mutation of α2 NKA, and immunoneutralization of EO with ouabain-binding Fab fragments. The NKA α2 CTS binding site and its endogenous ligand are required for BP elevation in many common hypertension models and full expression of cardiac remodeling and dysfunction following pressure overload or myocardial infarction. Understanding how endogenous CTS impact hypertension and HF pathophysiology and therapy should foster reconsideration of digoxin's therapeutic utility.
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Affiliation(s)
- Mordecai P Blaustein
- Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Stephen S Gottlieb
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - John M Hamlyn
- Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Frans H H Leenen
- Brain and Heart Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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11
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Huggins GS, Kinnamon DD, Haas GJ, Jordan E, Hofmeyer M, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Aaronson KD, Fishbein DP, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Mead JO, Ni H, Burke W, Hershberger RE. Prevalence and Cumulative Risk of Familial Idiopathic Dilated Cardiomyopathy. JAMA 2022; 327:454-463. [PMID: 35103767 PMCID: PMC8808323 DOI: 10.1001/jama.2021.24674] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/22/2021] [Indexed: 12/19/2022]
Abstract
Importance Idiopathic dilated cardiomyopathy (DCM) aggregates in families, and early detection in at-risk family members can provide opportunity to initiate treatment prior to late-phase disease. Most studies have included only White patients, yet Black patients with DCM have higher risk of heart failure-related hospitalization and death. Objective To estimate the prevalence of familial DCM among DCM probands and the age-specific cumulative risk of DCM in first-degree relatives across race and ethnicity groups. Design, Setting, and Participants A family-based, cross-sectional study conducted by a multisite consortium of 25 US heart failure programs. Participants included patients with DCM (probands), defined as left ventricular systolic dysfunction and left ventricular enlargement after excluding usual clinical causes, and their first-degree relatives. Enrollment commenced June 7, 2016; proband and family member enrollment concluded March 15, 2020, and April 1, 2021, respectively. Exposures The presence of DCM in a proband. Main Outcomes and Measures Familial DCM defined by DCM in at least 1 first-degree relative; expanded familial DCM defined by the presence of DCM or either left ventricular enlargement or left ventricular systolic dysfunction without known cause in at least 1 first-degree relative. Results The study enrolled 1220 probands (median age, 52.8 years [IQR, 42.4-61.8]; 43.8% female; 43.1% Black and 8.3% Hispanic) and screened 1693 first-degree relatives for DCM. A median of 28% (IQR, 0%-60%) of living first-degree relatives were screened per family. The crude prevalence of familial DCM among probands was 11.6% overall. The model-based estimate of the prevalence of familial DCM among probands at a typical US advanced heart failure program if all living first-degree relatives were screened was 29.7% (95% CI, 23.5% to 36.0%) overall. The estimated prevalence of familial DCM was higher in Black probands than in White probands (difference, 11.3% [95% CI, 1.9% to 20.8%]) but did not differ significantly between Hispanic probands and non-Hispanic probands (difference, -1.4% [95% CI, -15.9% to 13.1%]). The estimated prevalence of expanded familial DCM was 56.9% (95% CI, 50.8% to 63.0%) overall. Based on age-specific disease status at enrollment, estimated cumulative risks in first-degree relatives at a typical US advanced heart failure program reached 19% (95% CI, 13% to 24%) by age 80 years for DCM and 33% (95% CI, 27% to 40%) for expanded DCM inclusive of partial phenotypes. The DCM hazard was higher in first-degree relatives of non-Hispanic Black probands than non-Hispanic White probands (hazard ratio, 1.89 [95% CI, 1.26 to 2.83]). Conclusions and Relevance In a US cross-sectional study, there was substantial estimated prevalence of familial DCM among probands and modeled cumulative risk of DCM among their first-degree relatives. Trial Registration ClinicalTrials.gov Identifier: NCT03037632.
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Affiliation(s)
- Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Garrie J. Haas
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
| | - Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Mark Hofmeyer
- Medstar Research Institute, Washington Hospital Center, Washington, DC
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha
| | | | | | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J.C. Walter Jr. Transplant Center, Houston, Texas
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | | | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stuart Katz
- New York University Langone Medical Center, New York
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, Florida
| | | | | | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles
| | | | | | | | - Jonathan O. Mead
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
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12
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Claxton L, Simmonds M, Beresford L, Cubbon R, Dayer M, Gottlieb SS, Hartshorne-Evans N, Kilroy B, Llewellyn A, Rothery C, Sharif S, Tierney JF, Witte KK, Wright K, Stewart LA. Coenzyme Q10 to manage chronic heart failure with a reduced ejection fraction: a systematic review and economic evaluation. Health Technol Assess 2022; 26:1-128. [PMID: 35076012 DOI: 10.3310/kvou6959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Chronic heart failure is a debilitating condition that accounts for an annual NHS spend of £2.3B. Low levels of endogenous coenzyme Q10 may exacerbate chronic heart failure. Coenzyme Q10 supplements might improve symptoms and slow progression. As statins are thought to block the production of coenzyme Q10, supplementation might be particularly beneficial for patients taking statins. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of coenzyme Q10 in managing chronic heart failure with a reduced ejection fraction. METHODS A systematic review that included randomised trials comparing coenzyme Q10 plus standard care with standard care alone in chronic heart failure. Trials restricted to chronic heart failure with a preserved ejection fraction were excluded. Databases including MEDLINE, EMBASE and CENTRAL were searched up to March 2020. Risk of bias was assessed using the Cochrane Risk of Bias tool (version 5.2). A planned individual participant data meta-analysis was not possible and meta-analyses were mostly based on aggregate data from publications. Potential effect modification was examined using meta-regression. A Markov model used treatment effects from the meta-analysis and baseline mortality and hospitalisation from an observational UK cohort. Costs were evaluated from an NHS and Personal Social Services perspective and expressed in Great British pounds at a 2019/20 price base. Outcomes were expressed in quality-adjusted life-years. Both costs and outcomes were discounted at a 3.5% annual rate. RESULTS A total of 26 trials, comprising 2250 participants, were included in the systematic review. Many trials were reported poorly and were rated as having a high or unclear risk of bias in at least one domain. Meta-analysis suggested a possible benefit of coenzyme Q10 on all-cause mortality (seven trials, 1371 participants; relative risk 0.68, 95% confidence interval 0.45 to 1.03). The results for short-term functional outcomes were more modest or unclear. There was no indication of increased adverse events with coenzyme Q10. Meta-regression found no evidence of treatment interaction with statins. The base-case cost-effectiveness analysis produced incremental costs of £4878, incremental quality-adjusted life-years of 1.34 and an incremental cost-effectiveness ratio of £3650. Probabilistic sensitivity analyses showed that at thresholds of £20,000 and £30,000 per quality-adjusted life-year coenzyme Q10 had a high probability (95.2% and 95.8%, respectively) of being more cost-effective than standard care alone. Scenario analyses in which the population and other model assumptions were varied all found coenzyme Q10 to be cost-effective. The expected value of perfect information suggested that a new trial could be valuable. LIMITATIONS For most outcomes, data were available from few trials and different trials contributed to different outcomes. There were concerns about risk of bias and whether or not the results from included trials were applicable to a typical UK population. A lack of individual participant data meant that planned detailed analyses of effect modifiers were not possible. CONCLUSIONS Available evidence suggested that, if prescribed, coenzyme Q10 has the potential to be clinically effective and cost-effective for heart failure with a reduced ejection fraction. However, given important concerns about risk of bias, plausibility of effect sizes and applicability of the evidence base, establishing whether or not coenzyme Q10 is genuinely effective in a typical UK population is important, particularly as coenzyme Q10 has not been subject to the scrutiny of drug-licensing processes. Stronger evidence is needed before considering its prescription in the NHS. FUTURE WORK A new independent, well-designed clinical trial of coenzyme Q10 in a typical UK heart failure with a reduced ejection fraction population may be warranted. STUDY REGISTRATION This study is registered as PROSPERO CRD42018106189. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Lindsay Claxton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lucy Beresford
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Richard Cubbon
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Mark Dayer
- Department of Cardiology, Somerset NHS Foundation Trust, University of Exeter, Exeter, UK
| | | | | | | | - Alexis Llewellyn
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Claire Rothery
- Centre for Health Economics, University of York, York, UK
| | - Sahar Sharif
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Jayne F Tierney
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Klaus K Witte
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lesley A Stewart
- Centre for Reviews and Dissemination, University of York, York, UK
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13
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Allen LA, Teerlink JR, Gottlieb SS, Ahmad T, Lam CSP, Psotka MA. Heart Failure Spending Function: An Investment Framework for Sequencing and Intensification of Guideline-Directed Medical Therapies. Circ Heart Fail 2022; 15:e008594. [PMID: 35000432 DOI: 10.1161/circheartfailure.121.008594] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/16/2022]
Abstract
Heart failure with reduced ejection fraction is managed with increasing numbers of guideline-directed medical therapies (GDMT). Benefits tend to be additive. Burdens can also be additive. We propose a heart failure spending function as a conceptual framework for tailored intensification of GDMT that maximizes therapeutic opportunity while limiting adverse events and patient burden. Each patient is conceptualized to have reserve in physiological and psychosocial domains, which can be spent for a future return on investment. Key domains are blood pressure, heart rate, serum creatinine, potassium, and out-of-pocket costs. For each patient, GDMT should be initiated and intensified in a sequence that prioritizes medications with the greatest expected cardiac benefit while drawing on areas where the patient has ample reserves. When reserve is underspent, patients fail to gain the full benefit of GDMT. Conversely, when a reserve is fully spent, addition of new drugs or higher doses that draw upon a domain will lead to patient harm. The benefit of multiple agents drawing upon varied physiological domains should be balanced against cost and complexity. Thresholds for overspending are explored, as are mechanisms for implementing these concepts into routine care, but further health care delivery research is needed to validate and refine clinical use of the spending function. The heart failure spending function also suggests how newer therapies may be considered in terms of relative value, prioritizing agents that draw on different spending domains from existing GDMT.
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Affiliation(s)
- Larry A Allen
- Division of Cardiology, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora (L.A.A.)
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and Department of Medicine, School of Medicine, University of California San Francisco (J.R.T.)
| | | | - Tariq Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (T.A.)
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore (C.S.P.L.)
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14
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Elliott P, Drachman BM, Gottlieb SS, Hoffman JE, Hummel SL, Lenihan DJ, Ebede B, Gundapaneni B, Li B, Sultan MB, Shah SJ. Long-Term Survival With Tafamidis in Patients With Transthyretin Amyloid Cardiomyopathy. Circ Heart Fail 2021; 15:e008193. [PMID: 34923848 PMCID: PMC8763250 DOI: 10.1161/circheartfailure.120.008193] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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] [Indexed: 11/29/2022]
Abstract
Background: Tafamidis is approved in many countries for the treatment of transthyretin amyloid cardiomyopathy. This study reports data on the long-term efficacy of tafamidis from an ongoing long-term extension (LTE) to the pivotal ATTR-ACT (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial). Methods: Patients with transthyretin amyloid cardiomyopathy who completed ATTR-ACT could enroll in an LTE, continuing with the same tafamidis dose or, if previously treated with placebo, randomized (2:1) to tafamidis meglumine 80 or 20 mg. All patients in the LTE transitioned to tafamidis free acid 61 mg (bioequivalent to tafamidis meglumine 80 mg) following a protocol amendment. In this interim analysis, all-cause mortality was assessed in patients treated with tafamidis meglumine 80 mg in ATTR-ACT continuing in the LTE, compared with those receiving placebo in ATTR-ACT transitioning to tafamidis in the LTE. Results: Median follow-up was 58.5 months in the continuous tafamidis group (n=176) and 57.1 months in the placebo to tafamidis group (n=177). There were 79 (44.9%) deaths with continuous tafamidis and 111 (62.7%) with placebo to tafamidis (hazard ratio, 0.59 [95% CI, 0.44–0.79]; P<0.001). Mortality was also reduced in the continuous tafamidis (versus placebo to tafamidis) subgroups of: variant transthyretin amyloidosis (0.57 [0.33–0.99]; P=0.05) and wild-type transthyretin amyloidosis (0.61 [0.43–0.87]; P=0.006); and baseline New York Heart Association class I and II (0.56 [0.38–0.82]; P=0.003) and class III (0.65 [0.41–1.01]; P=0.06). Conclusions: In the LTE, patients initially treated with tafamidis in ATTR-ACT had substantially better survival than those first treated with placebo, highlighting the importance of early diagnosis and treatment in transthyretin amyloid cardiomyopathy. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01994889 and NCT02791230.
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Affiliation(s)
| | - Brian M Drachman
- Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.M.D.)
| | | | | | - Scott L Hummel
- University of Michigan and Ann Arbor Veterans Affairs Health System (S.L.H.)
| | - Daniel J Lenihan
- Washington University School of Medicine, St. Louis, MO (D.J.L.)
| | | | | | | | | | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
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15
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Rosano GMC, Allen LA, Abdin A, Lindenfeld J, O'Meara E, Lam CSP, Lancellotti P, Savarese G, Gottlieb SS, Teerlink J, Wintrich J, Böhm M. Drug Layering in Heart Failure: Phenotype-Guided Initiation. JACC Heart Fail 2021; 9:775-783. [PMID: 34627725 DOI: 10.1016/j.jchf.2021.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 12/11/2022]
Abstract
Medications with proven benefit in patients with heart failure with reduced ejection fraction are recommended, according to prospective large clinical trials, in the stable patient after careful up-titration in a strict sequential order. Although the relevance of careful clinical up-titration is unproven, there is evidence that after recompensation and shortly after hospital discharge, the rate of cardiovascular death and hospitalization is high. Clinical studies provided evidence that the onset of treatment effects is rapid, occurring within 28 days with most of these drugs used, and in some trials, early treatment after discharge or already started in the hospital has provided benefits. Therefore, early treatment without deferring it to the stable outpatient may be useful to reduce cardiac-related events further. This expert opinion proposes treatment layering according to individual patient phenotypes involving heart rate, blood pressure, impaired renal function, and electrolyte disturbances, as well as dedicated subgroups of patients with specific requirements for treatment initiation. This complements other approaches that suggest starting sequential treatment according to the size of treatment effects of drugs, specific cardiac diseases, and patient wishes. Patient phenotyping may guide personalized drug layering in heart failure with reduced ejection fraction that provides the best outcomes, whereas pragmatic clinical trials are warranted to scrutinize the effectiveness of these approaches.
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Affiliation(s)
- Giuseppe M C Rosano
- Centre for Clinical and Basic Research, IRCCS San Raffaele Roma, Rome, Italy
| | - Larry A Allen
- Division of Cardiology, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Amr Abdin
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Joann Lindenfeld
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eileen O'Meara
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Carolyn S P Lam
- Duke-National University of Singapore and National Heart Centre Singapore, Singapore
| | | | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Stephen S Gottlieb
- University of Maryland School of Medicine and Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - John Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Jan Wintrich
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany.
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16
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Gottlieb SS, Psotka MA, Desai N, Lindenfeld J, Russo P, Allen LA. Use of Outpatient Intravenous Calcitropes for Heart Failure in the United States. J Card Fail 2021; 27:1276-1279. [PMID: 34265464 DOI: 10.1016/j.cardfail.2021.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Outpatient calcitrope infusions-that is, the cardiac inotropes milrinone and dobutamine-are often used for bridge to transplantation and palliation in advanced heart failure, but few data exist about the real-world use of these agents. METHODS AND RESULTS We used the Symphony Integrated DataVerse of commercial, managed Medicare, and Medicaid insurance claims of approximately 280 million people (2012-2020) to determine the incidence and characteristics of ambulatory calcitrope use. Demographics were calculated, including geographic densities at the metropolitan statistical area level. A population projection normalized for age, sex, and location was extrapolated to the total US population. Ambulatory dispensing of milrinone was found in 10,533 outpatients, 1867 in 2019. Ambulatory dobutamine use was found in 4967 outpatients, 836 in 2019. The 2019 total US projection was 3411 for milrinone and 1281 for dobutamine. The mean age was 62 years for milrinone and 68 for dobutamine. Males represented 70% of use. There were differences between drugs in geographic distribution, with more milrinone use in the Northeast and South and more dobutamine use in the Midwest. Duration of use was 4.6 ± 7.2 months for milrinone and 1.8 ± 4.0 months for dobutamine. Of the patients receiving milrinone, 30.6% subsequently underwent cardiac transplantation or left ventricular assist device placement, whereas 10% receiving dobutamine went on to advanced therapies. Less than 0.5% of patients received calcitropes while enrolled in hospice care. CONCLUSIONS More than 4000 patients receive outpatient infusion of calcitropes annually in the outpatient setting. Men are much more likely to receive these medications. A minority of the use is as a bridge to advanced therapies. Geographic variability in use suggests better evidence and consistent guidelines may be helpful.
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Affiliation(s)
- Stephen S Gottlieb
- University of Maryland School of Medicine and Baltimore VAMC, Baltimore, Maryland.
| | | | | | | | - Pierantonio Russo
- Spring Hills-Population Health, Edison, NJ and Eversana Analytics, Milwaukee, WI
| | - Larry A Allen
- University of Colorado School of Medicine, Aurora, Colorado
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Abstract
Heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) constitute a high-risk phenotype with significant morbidity and mortality and poor prognosis. Multiple proinflammatory comorbid conditions influence the pathogenesis of HFpEF and CKD. Renal dysfunction in HFpEF is a consequence of the complex interplay between hemodynamic factors, systemic congestion, inflammation, endothelial dysfunction, and neurohormonal mechanisms. In contrast to heart failure with reduced ejection fraction, there is a dearth of effective targeted therapies for HFpEF. Tailoring study design toward the different phenotypes and delving into their pathophysiology may be fruitful in development of effective phenotype-specific targeted pharmaceutical therapies.
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Affiliation(s)
- Manjula G Ananthram
- Department of Internal Medicine, Division of Cardiology, University of Maryland, 110 South Paca Street, 7th Floor, Baltimore, MD 21201, USA.
| | - Stephen S Gottlieb
- Department of Internal Medicine, Division of Cardiology, University of Maryland, 110 South Paca Street, 7th Floor, Baltimore, MD 21201, USA
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18
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Polanka BM, Kundu S, So-Armah KA, Freiberg MS, Gupta SK, Zapolski TCB, Hirsh AT, Bedimo RJ, Budoff MJ, Butt AA, Chang CCH, Gottlieb SS, Marconi VC, Womack JA, Stewart JC. Insomnia symptoms and biomarkers of monocyte activation, systemic inflammation, and coagulation in HIV: Veterans Aging Cohort Study. PLoS One 2021; 16:e0246073. [PMID: 33561176 PMCID: PMC7872271 DOI: 10.1371/journal.pone.0246073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022] Open
Abstract
Background Insomnia may be a risk factor for cardiovascular disease in HIV (HIV-CVD); however, mechanisms have yet to be elucidated. Methods We examined cross-sectional associations of insomnia symptoms with biological mechanisms of HIV-CVD (immune activation, systemic inflammation, and coagulation) among 1,542 people with HIV from the Veterans Aging Cohort Study (VACS) Biomarker Cohort. Past-month insomnia symptoms were assessed by the item, “Difficulty falling or staying asleep?,” with the following response options: “I do not have this symptom” or “I have this symptom and…” “it doesn’t bother me,” “it bothers me a little,” “it bothers me,” “it bothers me a lot.” Circulating levels of the monocyte activation marker soluble CD14 (sCD14), inflammatory marker interleukin-6 (IL-6), and coagulation marker D-dimer were determined from blood specimens. Demographic- and fully-adjusted (CVD risk factors, potential confounders, HIV-related factors) regression models were constructed, with log-transformed biomarker variables as the outcomes. We present the exponentiated regression coefficient (exp[b]) and its 95% confidence interval (CI). Results We observed no significant associations between insomnia symptoms and sCD14 or IL-6. For D-dimer, veterans in the “Bothers a Lot” group had, on average, 17% higher D-dimer than veterans in the “No Difficulty Falling or Staying Asleep” group in the demographic-adjusted model (exp[b] = 1.17, 95%CI = 1.01–1.37, p = .04). This association was nonsignificant in the fully-adjusted model (exp[b] = 1.09, 95%CI = 0.94–1.26, p = .27). Conclusion We observed little evidence of relationships between insomnia symptoms and markers of biological mechanisms of HIV-CVD. Other mechanisms may be responsible for the insomnia-CVD relationship in HIV; however, future studies with comprehensive assessments of insomnia symptoms are warranted.
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Affiliation(s)
- Brittanny M Polanka
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Suman Kundu
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Kaku A So-Armah
- Division of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Matthew S Freiberg
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Samir K Gupta
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Tamika C B Zapolski
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, United States of America
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, United States of America
| | - Roger J Bedimo
- Division of Infectious Diseases, VA North Texas Healthcare System, Dallas, Texas, United States of America
| | - Matthew J Budoff
- Lundquist Institute, Torrance, California, United States of America
| | - Adeel A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America
- Weill Cornell Medical College, Doha, Qatar, and New York City, New York, United States of America
- Hamad Medical Corp, Doha, Qatar
| | - Chung-Chou H Chang
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Stephen S Gottlieb
- Department of Medicine, University of Maryland School of Medicine and Baltimore VAMC, Baltimore, Maryland, United States of America
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Atlanta VA Medical Center, Atlanta, Georgia, United States of America
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, Unites States of America
| | - Julie A Womack
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
- Yale University School of Nursing, West Haven, Connecticut, United States of America
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, United States of America
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19
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Gottlieb SS, Ahmed T. Consider Everything When Prescribing Sacubitril/Valsartan. J Am Coll Cardiol 2020; 76:1049-1050. [DOI: 10.1016/j.jacc.2020.03.090] [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] [Received: 03/11/2020] [Accepted: 03/30/2020] [Indexed: 11/25/2022]
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20
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Harris KM, Gottdiener JS, Gottlieb SS, Burg MM, Li S, Krantz DS. Impact of Mental Stress and Anger on Indices of Diastolic Function in Patients With Heart Failure. J Card Fail 2020; 26:1006-1010. [PMID: 32750485 DOI: 10.1016/j.cardfail.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/21/2020] [Accepted: 07/07/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Under controlled conditions, mental stress can provoke decrements in ventricular function, yet little is known about the effect of mental stress on diastolic function in patients with heart failure (HF). METHODS AND RESULTS Twenty-four patients with HF with ischemic cardiomyopathy and reduced ejection fraction (n = 23 men; mean left ventricular [LV] ejection fraction 27 ± 9%; n = 13 with baseline elevated E/e') completed daily assessment of perceived stress, anger, and negative emotion for 7 days, followed by a laboratory mental stress protocol. Two-dimensional Doppler echocardiography was performed at rest and during sequential anger recall and mental arithmetic tasks to assess indices of diastolic function (E, e', and E/e'). Fourteen patients (63.6%) experienced stress-induced increases in E/e', with an average baseline to stress change of 6.5 ± 9.3, driven primarily by decreases in early LV relaxation (e'). Age-adjusted linear regression revealed an association between 7-day anger and baseline E/e'; patients reporting greater anger in the week before mental stress exhibited higher resting LV diastolic pressure. CONCLUSIONS In patients with HF with reduced ejection fraction, mental stress can provoke acute worsening of LV diastolic pressure, and recent anger is associated with worse resting LV diastolic pressure. In patients vulnerable to these effects, repeated stress exposures or experiences of anger may have implications for long-term outcomes.
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Affiliation(s)
- Kristie M Harris
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut.
| | | | | | - Matthew M Burg
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut; Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Shuying Li
- Division of Cardiology, University of Maryland, Baltimore, Maryland
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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21
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Faselis C, Arundel C, Patel S, Lam PH, Gottlieb SS, Zile MR, Deedwania P, Filippatos G, Sheriff HM, Zeng Q, Morgan CJ, Wopperer S, Nguyen T, Allman RM, Fonarow GC, Ahmed A. Loop Diuretic Prescription and 30-Day Outcomes in Older Patients With Heart Failure. J Am Coll Cardiol 2020; 76:669-679. [DOI: 10.1016/j.jacc.2020.06.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/17/2023]
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22
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Hankinson SJ, Williams CH, Ton VK, Gottlieb SS, Hong CC. Should we overcome the resistance to bioelectrical impedance in heart failure? Expert Rev Med Devices 2020; 17:785-794. [PMID: 32658589 DOI: 10.1080/17434440.2020.1791701] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Heart failure is associated with increased neurohormonal activation that results in changes in body composition including volume overload and the loss of skeletal muscle, body fat, and bone density. Bioelectrical impedance measures body composition based on the conduction of electrical current through body fluids. AREAS COVERED The PubMed and Scopus databases were reviewed up to the third week of June 2020. Cross-sectional studies, retrospective observational studies, prospective observational studies, and randomized controlled trials have examined numerous bioelectrical impedance monitoring strategies to guide the diagnosis, prognosis, and treatment of heart failure. These monitoring strategies include intrathoracic impedance, lung impedance, bioelectrical impedance vector analysis, leg bioelectrical impedance, and thoracic bioreactance. EXPERT COMMENTARY Based on the current evidence, more studies are needed to validate bioelectrical impedance in heart failure. Lung impedance appears to be useful for guiding heart failure treatment in patients with ST-elevation myocardial infarction and improving outcomes in outpatients with heart failure. Furthermore, bioelectrical impedance has potential as a noninvasive, quantitative heart failure variable for population-based research.
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Affiliation(s)
- Stephen J Hankinson
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine , Baltimore, MD, USA
| | - Charles H Williams
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine , Baltimore, MD, USA
| | - Van-Khue Ton
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine , Baltimore, MD, USA.,Harvard Medical School, Division of Cardiology, Massachusetts General Hospital , Boston, MA, USA
| | - Stephen S Gottlieb
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine , Baltimore, MD, USA
| | - Charles C Hong
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine , Baltimore, MD, USA
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23
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Elliott P, Drachman BM, Gottlieb SS, Hoffman JE, Hummel SL, Lenihan DJ, Ebede B, Gundapaneni B, Schwartz JH, Sultan MB, Shah SJ. 1169Interim analysis of data from a long-term, extension trial of tafamidis meglumine in patients with transthyretin amyloid cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/14/2022] Open
Abstract
Abstract
Background
Transthyretin amyloid cardiomyopathy (ATTR-CM), is an underdiagnosed, fatal disease caused by the deposition of transthyretin amyloid fibrils in the heart leading to heart failure. The Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT), an international, multi-center, double-blind, placebo-controlled, randomized study, demonstrated the efficacy and safety of tafamidis treatment for patients with ATTR-CM due to variant (ATTRm) or wild-type (ATTRwt) TTR.
Purpose
This is a pooled analysis of data from ATTR-ACT and interim data from the ongoing, long-term, extension study to evaluate longer term data on the efficacy of tafamidis in patients with ATTR-CM.
Methods
Patients who completed ATTR-ACT (which had a duration of 30 months) were eligible to be enrolled in a long-term, extension study in which patients either continued to receive tafamidis meglumine at the same dose (the tafamidis/tafamidis [T/T] group) or, for patients previously treated with placebo, were randomised (in a 1:2 ratio) to tafamidis meglumine 20 mg or 80 mg (the placebo/tafamidis [P/T] group) for up to 60 months. The primary efficacy outcome was all-cause mortality. This analysis combined data from the completed ATTR-ACT with interim data from the extension study (cut-off date: 15 Feb, 2018), and included patients treated with tafamidis meglumine across the two studies with a median follow up of 36 months.
Results
All-cause mortality was significantly lower in the T/T group (n=264; 88 events, 33.3%) compared with the P/T group (n=177; 88 events, 50.3%); hazard ratio (95% CI), 0.64 (0.47, 0.85); P=0.001. In the subgroup of ATTRwt patients, all-cause mortality was significantly reduced in the T/T group (55/201; 27.4%) compared with the P/T group (60/134; 44.8%); 0.64 (0.44, 0.92); P=0.002. In the 106 (24.0%) ATTRm patients, there was a trend towards a reduction in all-cause mortality in the T/T group (33/63; 52.4%) compared with the P/T group (29/43; 67.4%); 0.66 (0.39, 1.09); P=0.17. In patients who were NYHA Class I or II at baseline, all-cause mortality was significantly reduced in the T/T group (38/186; 20.4%) compared with the P/T group (45/114; 39.5%); 0.49 (0.32, 0.75); P=0.001. In those patients with more severe symptoms at baseline (NYHA Class III), there were fewer deaths in the T/T group (50/78; 64.1%) compared with the P/T group (44/63; 69.8%); 0.80 (0.53, 1.21), but this difference was not statistically significant (P=0.50).
Conclusions
In ATTR-ACT, tafamidis was shown to significantly improve survival, functional capacity, and quality of life in patients with ATTR-CM. This pooled analysis with data from the ongoing extension study further supports the efficacy of tafamidis in patients over a longer period of time and the importance of early diagnosis and treatment.
Acknowledgement/Funding
This study was sponsored by Pfizer.
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Affiliation(s)
- P Elliott
- University College London, London, United Kingdom
| | - B M Drachman
- Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, United States of America
| | - S S Gottlieb
- University of Maryland, School of Medicine, Baltimore, United States of America
| | - J E Hoffman
- University of Miami, Miami, United States of America
| | - S L Hummel
- University of Michigan, Ann Arbor, United States of America
| | - D J Lenihan
- Washington University School of Medicine, St. Louis, United States of America
| | - B Ebede
- Pfizer Inc, Collegeville, United States of America
| | | | | | - M B Sultan
- Pfizer Inc, New York, United States of America
| | - S J Shah
- Northwestern University Feinberg School of Medicine, Division of Cardiology, Department of Medicine, Chicago, United States of America
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24
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Abdel-Qadir H, Gottlieb SS. Trajectories of Renal Function During Heart Failure Hospitalization: Beware the Bumpy Ride! J Card Fail 2019; 25:875-876. [PMID: 31634573 DOI: 10.1016/j.cardfail.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Husam Abdel-Qadir
- Women's College Hospital and University Health Network, Toronto, Canada.
| | - Stephen S Gottlieb
- University of Maryland School of Medicine and Baltimore VAMC, Baltimore, MD
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25
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Endrighi R, Dimond AJ, Waters AJ, Dimond CC, Harris KM, Gottlieb SS, Krantz DS. Associations of perceived stress and state anger with symptom burden and functional status in patients with heart failure. Psychol Health 2019; 34:1250-1266. [PMID: 31111738 DOI: 10.1080/08870446.2019.1609676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Psychosocial stress and anger trigger cardiovascular events, but their relationship to heart failure (HF) exacerbations is unclear. We investigated perceived stress and anger associations with HF functional status and symptoms. Methods and Results: In a prospective cohort study (BETRHEART), 144 patients with HF (77% male; 57.5 ± 11.5 years) were evaluated for perceived stress (Perceived Stress Scale; PSS) and state anger (STAXI) at baseline and every 2 weeks for 3 months. Objective functional status (6-min walk test; 6MWT) and health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) were also measured biweekly. Linear mixed model analyses indicated that average PSS and greater than usual increases in PSS were associated with worsened KCCQ scores. Greater than usual increases in PSS were associated with worsened 6MWT. Average anger levels were associated with worsened KCCQ, and increases in anger were associated with worsened 6MWT. Adjusting for PSS, anger associations were no longer statistically significant. Adjusting for anger, PSS associations with KCCQ and 6MWT remained significant. Conclusion: In patients with HF, both perceived stress and anger are associated with poorer functional and health status, but perceived stress is a stronger predictor. Negative effects of anger on HF functional status and health status may partly operate through psychological stress.
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Affiliation(s)
- Romano Endrighi
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA.,Center for Behavioral Science Research, Department of Health Policy, Health Services Research, Boston University Henry M. Goldman School of Dental Medicine , Boston , MA , USA
| | - Andrew J Dimond
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | | | - Kristie M Harris
- Section on Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine , New Haven , CT , USA
| | - Stephen S Gottlieb
- Department of Medicine, University of Maryland School of Medicine , Baltimore , MD , USA
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
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Psotka MA, Gottlieb SS, Francis GS, Allen LA, Teerlink JR, Adams KF, Rosano GM, Lancellotti P. Cardiac Calcitropes, Myotropes, and Mitotropes. J Am Coll Cardiol 2019; 73:2345-2353. [DOI: 10.1016/j.jacc.2019.02.051] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/12/2019] [Indexed: 01/19/2023]
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Reed BN, Gottlieb SS. Diuretic Strategies and Renal Dysfunction in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail 2018; 6:1049-1050. [PMID: 30497646 DOI: 10.1016/j.jchf.2018.08.006] [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] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 06/09/2023]
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Maurer MS, Schwartz JH, Gundapaneni B, Elliott P, Merlini G, Cruz MW, Kristen AV, Grogan M, Witteles R, Damy T, Drachman BM, Shah SJ, Hanna M, Judge DP, Gottlieb SS, Berk JL, Lenihan DJ, Hoffman JE, Hummel SL, Velazquez EJ, Patterson TA, Sultan MB, Rapezzi C. Efficacy of Tafamidis in Transthyretin Amyloid Cardiomyopathy in the ATTR-ACT Trial: Sensitivity Analyses Further Support the Primary Results. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.11.008] [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: 11/27/2022]
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Affiliation(s)
- Stephen S Gottlieb
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore VA Medical Center.
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Abstract
PURPOSE OF REVIEW This paper reviews treatment options for sleep disordered breathing (SDB) in patients with heart failure. We sought to identify therapies for SDB with the best evidence for long-term use in patients with heart failure and to minimize uncertainties in clinical practice by examining frequently discussed questions: what is the role of continuous positive airway pressure (CPAP) in patients with heart failure? Is adaptive servo-ventilation (ASV) safe in patients with heart failure? To what extent is SDB a modifiable risk factor? RECENT FINDINGS Consistent evidence has demonstrated that the development of SDB in patients with heart failure is a poor prognostic indicator and a risk factor for cardiovascular mortality. However, despite numerous available interventions for obstructive sleep apnea and central sleep apnea, it remains unclear what effect these therapies have on patients with heart failure. To date, all major randomized clinical trials have failed to demonstrate a survival benefit with SDB therapy and one major study investigating the use of adaptive servo-ventilation demonstrated harm. Significant questions persist regarding the management of SDB in patients with heart failure. Until appropriately powered trials identify a treatment modality that increases cardiovascular survival in patients with SDB and heart failure, a patient's heart failure management should remain the priority of medical care.
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Affiliation(s)
- Connor P Oates
- School of Medicine, University of Maryland, Baltimore, MD, USA
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Xu H, Dorn GW, Shetty A, Parihar A, Dave T, Robinson SW, Gottlieb SS, Donahue MP, Tomaselli GF, Kraus WE, Mitchell BD, Liggett SB. A Genome-Wide Association Study of Idiopathic Dilated Cardiomyopathy in African Americans. J Pers Med 2018; 8:E11. [PMID: 29495422 PMCID: PMC5872085 DOI: 10.3390/jpm8010011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/17/2018] [Accepted: 02/21/2018] [Indexed: 01/03/2023] Open
Abstract
Idiopathic dilated cardiomyopathy (IDC) is the most common form of non-ischemic chronic heart failure. Despite the higher prevalence of IDC in African Americans, the genetics of IDC have been relatively understudied in this ethnic group. We performed a genome-wide association study to identify susceptibility genes for IDC in African Americans recruited from five sites in the U.S. (662 unrelated cases and 1167 controls). The heritability of IDC was calculated to be 33% (95% confidence interval: 19-47%; p = 6.4 × 10-7). We detected association of a variant in a novel intronic locus in the CACNB4 gene meeting genome-wide levels of significance (p = 4.1 × 10-8). The CACNB4 gene encodes a calcium channel subunit expressed in the heart that is important for cardiac muscle contraction. This variant has not previously been associated with IDC in any racial group. Pathway analysis, based on the 1000 genes most strongly associated with IDC, showed an enrichment for genes related to calcium signaling, growth factor signaling, neuronal/neuromuscular signaling, and various types of cellular level signaling, including gap junction and cAMP signaling. Our results suggest a novel locus for IDC in African Americans and provide additional insights into the genetic architecture and etiology.
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Affiliation(s)
- Huichun Xu
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Gerald W Dorn
- Center for Pharmacogenomics, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Amol Shetty
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Ankita Parihar
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Tushar Dave
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Shawn W Robinson
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Stephen S Gottlieb
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Mark P Donahue
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27708, USA.
| | - Gordon F Tomaselli
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA.
| | - William E Kraus
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC 27708, USA.
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27701, USA.
| | - Braxton D Mitchell
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
- Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD 21201, USA.
| | - Stephen B Liggett
- Department of Internal Medicine and Molecular Pharmacology and Physiology, and the Center for Personalized Medicine and Genomics, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.
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Laliberte B, Reed BN, Devabhakthuni S, Watson K, Ivaturi V, Liu T, Gottlieb SS. Observation of Patients Transitioned to an Oral Loop Diuretic Before Discharge and Risk of Readmission for Acute Decompensated Heart Failure. J Card Fail 2017; 23:746-752. [PMID: 28688888 DOI: 10.1016/j.cardfail.2017.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/09/2017] [Accepted: 06/29/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Heart failure (HF) is associated with high 30-day readmission rates and places significant financial burden on the health care system. The aim of this study was to determine if the duration of observation on an oral loop diuretic before discharge is associated with a reduction in 30-day HF readmission in patients with acute decompensated HF (ADHF). METHODS AND RESULTS This was a retrospective study of adult patients admitted for ADHF at a large academic medical center. A total of 123 patients were included. Baseline characteristics were similar between groups. The primary outcome of 30-day HF readmission occurred in 11 of 61 patients (18%) observed on an oral loop diuretic for <24 hours and in 2 of 62 patients (3.2%) observed on an oral loop diuretic for ≥24 hours (P = .023). Readmissions for 60- and 90-day HF were also significantly lower in patients observed for ≥24 hours (P = .014 and P = .049, respectively). Associations became stronger after multivariate analysis (P < .001). Observation for <24 hours and previous admission within 30 days were independent predictors of 30-day HF readmission (P = .03). CONCLUSIONS Observation of patients on an oral loop diuretic for <24 hours was associated with significantly higher 30-day HF readmission. Therefore, observation on an oral loop diuretic for ≥24 hours before discharge in patients presenting with ADHF should be strongly considered.
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Affiliation(s)
- Benjamin Laliberte
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland; Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts.
| | - Brent N Reed
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland; Applied Therapeutics, Research, and Instruction at the University of Maryland (ATRIUM) Cardiology Collaborative, Baltimore, Maryland
| | - Sandeep Devabhakthuni
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland; Applied Therapeutics, Research, and Instruction at the University of Maryland (ATRIUM) Cardiology Collaborative, Baltimore, Maryland
| | - Kristin Watson
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland; Applied Therapeutics, Research, and Instruction at the University of Maryland (ATRIUM) Cardiology Collaborative, Baltimore, Maryland
| | - Vijay Ivaturi
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Tao Liu
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Stephen S Gottlieb
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Tita C, Gilbert EM, Van Bakel AB, Grzybowski J, Haas GJ, Jarrah M, Dunlap SH, Gottlieb SS, Klapholz M, Patel PC, Pfister R, Seidler T, Shah KB, Zieliński T, Venuti RP, Cowart D, Foo SY, Vishnevsky A, Mitrovic V. A Phase 2a dose-escalation study of the safety, tolerability, pharmacokinetics and haemodynamic effects of BMS-986231 in hospitalized patients with heart failure with reduced ejection fraction. Eur J Heart Fail 2017; 19:1321-1332. [PMID: 28677877 PMCID: PMC6607490 DOI: 10.1002/ejhf.897] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 11/16/2016] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 12/28/2022] Open
Abstract
Aims This study was designed to evaluate the safety, tolerability and haemodynamic effects of BMS‐986231, a novel second‐generation nitroxyl donor with potential inotropic, lusitropic and vasodilatory effects in patients hospitalized with decompensated heart failure and reduced ejection fraction (HFrEF). Methods and results Forty‐six patients hospitalized with decompensated HFrEF were enrolled into four sequential dose‐escalation cohorts in this double‐blind, randomized, placebo‐controlled Phase 2a study. Patients with baseline pulmonary capillary wedge pressure (PCWP) of ≥20 mmHg and a cardiac index of ≤2.5 L/min/m2 received one 6‐h i.v. infusion of BMS‐986231 (at 3, 5, 7 or 12 µg/kg/min) or placebo. BMS‐986231 produced rapid and sustained reductions in PCWP, as well as consistent reductions in time‐averaged pulmonary arterial systolic pressure, pulmonary arterial diastolic pressure and right atrial pressure. BMS‐986231 increased non‐invasively measured time‐averaged stroke volume index, cardiac index and cardiac power index values, and decreased total peripheral vascular resistance. There was no evidence of increased heart rate, drug‐related arrhythmia or symptomatic hypotension with BMS‐986231. Analyses of adverse events throughout the 30‐day follow‐up did not identify any toxicities specific to BMS‐986231, with the potential exception of infrequent mild‐to‐moderate headaches during infusion. There were no treatment‐related serious adverse events. Conclusions BMS‐986231 demonstrated a favourable safety and haemodynamic profile in patients hospitalized with advanced heart failure. Based on preclinical data and these study's findings, it is possible that the haemodynamic benefits may be mediated by inotropic and/or lusitropic as well as vasodilatory effects. The therapeutic potential of BMS‐986231 should be further assessed in patients with heart failure.
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Affiliation(s)
- Cristina Tita
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Edward M Gilbert
- Division of Cardiology, Faculty of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Adrian B Van Bakel
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Garrie J Haas
- Division of Cardiology and Vascular Medicine, Faculty of Medicine, Ohio State University, Columbus, OH, USA
| | - Mohammad Jarrah
- Department of Cardiology, King Abdullah University Hospital, Irbid, Jordan
| | - Stephanie H Dunlap
- Division of Cardiology, Faculty of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Stephen S Gottlieb
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marc Klapholz
- Division of Cardiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Parag C Patel
- Department of Transplant, Mayo Clinic, Jacksonville, FL, USA
| | - Roman Pfister
- Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Cologne, Germany
| | - Tim Seidler
- Division of Cardiology and Pulmonology, Medical University of Göttingen, Göttingen, Germany
| | - Keyur B Shah
- Department of Cardiology, Faculty of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Tomasz Zieliński
- Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Poland
| | - Robert P Venuti
- formerly of Cardioxyl Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Douglas Cowart
- formerly of Cardioxyl Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Shi Yin Foo
- formerly of Cardioxyl Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Alexander Vishnevsky
- Intensive Care Unit, Cardiology Department, Pokrovskaya City Hospital, St Petersburg, Russia
| | - Veselin Mitrovic
- Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
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Maurer MS, Hanna M, Grogan M, Dispenzieri A, Witteles R, Drachman B, Judge DP, Lenihan DJ, Gottlieb SS, Shah SJ, Steidley DE, Ventura H, Murali S, Silver MA, Jacoby D, Fedson S, Hummel SL, Kristen AV, Damy T, Planté-Bordeneuve V, Coelho T, Mundayat R, Suhr OB, Waddington Cruz M, Rapezzi C. Genotype and Phenotype of Transthyretin Cardiac Amyloidosis: THAOS (Transthyretin Amyloid Outcome Survey). J Am Coll Cardiol 2017; 68:161-72. [PMID: 27386769 DOI: 10.1016/j.jacc.2016.03.596] [Citation(s) in RCA: 301] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 03/23/2016] [Accepted: 03/29/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Transthyretin amyloidosis (ATTR) is a heterogeneous disorder with multiorgan involvement and a genetic or nongenetic basis. OBJECTIVES The goal of this study was to describe ATTR in the United States by using data from the THAOS (Transthyretin Amyloidosis Outcomes Survey) registry. METHODS Demographic, clinical, and genetic features of patients enrolled in the THAOS registry in the United States (n = 390) were compared with data from patients from other regions of the world (ROW) (n = 2,140). The focus was on the phenotypic expression and survival in the majority of U.S. subjects with valine-to-isoleucine substitution at position 122 (Val122Ile) (n = 91) and wild-type ATTR (n = 189). RESULTS U.S. subjects are older (70 vs. 46 years), more often male (85.4% vs. 50.6%), and more often of African descent (25.4% vs. 0.5%) than the ROW. A significantly higher percentage of U.S. patients with ATTR amyloid seen at cardiology sites had wild-type disease than the ROW (50.5% vs. 26.2%). In the United States, 34 different mutations (n = 201) have been reported, with the most common being Val122Ile (n = 91; 45.3%) and Thr60Ala (n = 41; 20.4%). Overall, 91 (85%) of 107 patients with Val122Ile were from the United States, where Val122Ile subjects were younger and more often female and black than patients with wild-type disease, and had similar cardiac phenotype but a greater burden of neurologic symptoms (pain, numbness, tingling, and walking disability) and worse quality of life. Advancing age and lower mean arterial pressure, but not the presence of a transthyretin mutation, were independently associated with higher mortality from a multivariate analysis of survival. CONCLUSIONS In the THAOS registry, ATTR in the United States is overwhelmingly a disorder of older adult male subjects with a cardiac-predominant phenotype. Val122Ile is the most common transthyretin mutation, and neurologic phenotypic expression differs between wild-type disease and Val122Ile, but survival from enrollment in THAOS does not. (Transthyretin-Associated Amyloidoses Outcome Survey [THAOS]; NCT00628745).
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Affiliation(s)
- Mathew S Maurer
- Columbia University College of Physicians and Surgeons, New York, New York.
| | | | | | | | - Ronald Witteles
- Stanford University School of Medicine, Stanford, California
| | - Brian Drachman
- Penn Philadelphia Heart Institute, Philadelphia, Pennsylvania
| | | | | | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Hector Ventura
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine New Orleans, Louisiana
| | | | | | | | | | - Scott L Hummel
- University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Arnt V Kristen
- Amyloidosis Center Medical University of Heidelberg, Heidelberg, Germany
| | - Thibaud Damy
- University Hospital Henri Mondor, Créteil, France
| | | | - Teresa Coelho
- Hospital de Santo António, Centro Hospitalar do Porto, Portugal
| | | | - Ole B Suhr
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Keith F, Krantz DS, Chen R, Harris KM, Ware CM, Lee AK, Bellini PG, Gottlieb SS. Anger, hostility, and hospitalizations in patients with heart failure. Health Psychol 2017. [PMID: 28650197 DOI: 10.1037/hea0000519] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Heart failure patients have a high hospitalization rate, and anger and hostility are associated with coronary heart disease morbidity and mortality. Using structural equation modeling, this prospective study assessed the predictive validity of anger and hostility traits for cardiovascular and all-cause rehospitalizations in patients with heart failure. METHOD 146 heart failure patients were administered the STAXI and Cook-Medley Hostility Inventory to measure anger, hostility, and their component traits. Hospitalizations were recorded for up to 3 years following baseline. Causes of hospitalizations were categorized as heart failure, total cardiac, noncardiac, and all-cause (sum of cardiac and noncardiac). RESULTS Measurement models were separately fit for Anger and Hostility, followed by a Confirmatory Factor Analysis to estimate the relationship between the Anger and Hostility constructs. An Anger model consisted of State Anger, Trait Anger, Anger Expression Out, and Anger Expression In, and a Hostility model included Cynicism, Hostile Affect, Aggressive Responding, and Hostile Attribution. The latent construct of Anger did not predict any of the hospitalization outcomes, but Hostility significantly predicted all-cause hospitalizations. Analyses of individual trait components of each of the 2 models indicated that Anger Expression Out predicted all-cause and noncardiac hospitalizations, and Trait Anger predicted noncardiac hospitalizations. None of the individual components of Hostility were related to rehospitalizations or death. CONCLUSION The construct of Hostility and several components of Anger are predictive of hospitalizations that were not specific to cardiac causes. Mechanisms common to a variety of health problems, such as self-care and risky health behaviors, may be involved in these associations. (PsycINFO Database Record
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Affiliation(s)
- Felicia Keith
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Rusan Chen
- Center for New Designs in Learning and Scholarship, Georgetown University
| | | | - Catherine M Ware
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Amy K Lee
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Paula G Bellini
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Stephen S Gottlieb
- Department of Medicine, Division of Cardiology, University of Maryland School of Medicine
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Harris KM, Krantz DS, Kop WJ, Marshall J, Robinson SW, Marshall JM, Gottlieb SS. A New Clinically Applicable Measure of Functional Status in Patients With Heart Failure: The 60-Foot Walk Test. JACC Heart Fail 2017; 5:411-420. [PMID: 28501523 DOI: 10.1016/j.jchf.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study reports the development and predictive value of the 60-foot walk test (60ftWT), a brief functional status measure for patients with heart failure (HF). The goal was to develop a test suitable for clinical settings and appropriate for patients with walking impairments. BACKGROUND The 6-min walk test (6MWT) has considerable predictive value, but requires a long walking course and has limited utility in patients with mobility-related comorbidities. A shorter, more clinically practical test is therefore needed. METHODS A total of 144 patients (age 57.4 ± 11.4 years; 111 males) with symptomatic HF received baseline assessments using the 60ftWT, 6MWT, and self-reported symptom and health status. Patients were tested 3 months later to determine stability of assessments. HF hospitalizations or death from any cause were recorded for 3.5 years following baseline. RESULTS Median 60ftWT completion time was 26 s (interquartile range: 22 to 31 s). Longer 60ftWT time was associated with shorter 6MWT distance (r = -0.75; p < 0.001), and with higher symptom severity at baseline (r = -0.40; p < 0.001). Longer 60ftWT times also predicted increases in 6MWT and symptoms from baseline to 3 months (p < 0.01). Both WTs predicted long-term clinical outcomes, with patients taking longer than 31 s to complete the 60ftWT at greatest risk for HF hospitalization or death (hazard ratio: 2.13; 95% confidence interval: 1.18 to 3.84; p = 0.01). CONCLUSIONS The 60ftWT is an easily administered functional status measure that predicts adverse events, symptoms, and health status. It has the potential for considerable clinical utility to help identify patients at risk for future events and to calibrate treatments designed to improve functional status and quality of life.
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Affiliation(s)
- Kristie M Harris
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | - Willem J Kop
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, the Netherlands
| | - Joanne Marshall
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore City, Maryland
| | - Shawn W Robinson
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore City, Maryland
| | - Jennifer M Marshall
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore City, Maryland
| | - Stephen S Gottlieb
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore City, Maryland
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Gottlieb SS. Surrogate Endpoints: Not the Real Thing. J Card Fail 2016; 22:761-2. [DOI: 10.1016/j.cardfail.2016.07.431] [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] [Received: 07/07/2016] [Revised: 07/06/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
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Endrighi R, Waters AJ, Gottlieb SS, Harris KM, Wawrzyniak AJ, Bekkouche NS, Li Y, Kop WJ, Krantz DS. Psychological stress and short-term hospitalisations or death in patients with heart failure. Heart 2016; 102:1820-1825. [PMID: 27357124 DOI: 10.1136/heartjnl-2015-309154] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 12/10/2015] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Standard predictors do not fully explain variations in the frequency and timing of heart failure (HF) adverse events (AEs). Psychological stress can trigger acute cardiovascular (CV) events, but it is not known whether stress can precipitate AEs in patients with HF. We investigated prospective associations of psychological stress with AEs in patients with HF. METHODS 144 patients with HF (77% male; 57.5±11.5, range 23-87 years, left ventricular ejection fraction ≤40%) were longitudinally evaluated for psychological stress (Perceived Stress Scale) and AEs (CV hospitalisations/death) at 2-week intervals for 3 months and at 9-month follow-up. RESULTS 42 patients (29.2%) had at least one CV hospitalisation and nine (6.3%) died. Patients reporting high average perceived stress across study measurements had a higher likelihood of AEs during the study period compared with those with lower stress (odds ratio=1.10, 95% confidence interval=1.04 to 1.17). In contrast to average levels, increases in stress did not predict AEs (p=0.96). Perceived stress was elevated after a CV hospitalisation (B=2.70, standard error (SE)=0.93, p=0.004) suggesting that CV hospitalisations increase stress. Subsequent analysis indicated that 24 of 38 (63%) patients showed a stress increase following hospitalisation. However, a prospective association between stress and AEs was present when accounting for prior hospitalisations (B=2.43, SE=1.23, p=0.05). CONCLUSIONS Sustained levels of perceived stress are associated with increased risk of AEs, and increased distress following hospitalisation occurs in many, but not all, patients with HF. Patients with chronically high stress may be an important target group for HF interventions aimed at reducing hospitalisations.
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Affiliation(s)
- Romano Endrighi
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Division of Behavioral Science Research, Department of Health Policy and Health Services Research, Boston University, Boston, Massachusetts, USA
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Kristie M Harris
- Cardiopulmonary Behavioral Medicine Laboratory, The Ohio State University, Columbus, Ohio, USA
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, Florida, USA
| | - Nadine S Bekkouche
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Willem J Kop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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White JR, Chang CCH, So-Armah KA, Stewart JC, Gupta SK, Butt AA, Gibert CL, Rimland D, Rodriguez-Barradas MC, Leaf DA, Bedimo RJ, Gottdiener JS, Kop WJ, Gottlieb SS, Budoff MJ, Khambaty T, Tindle HA, Justice AC, Freiberg MS. Depression and human immunodeficiency virus infection are risk factors for incident heart failure among veterans: Veterans Aging Cohort Study. Circulation 2015; 132:1630-8. [PMID: 26358261 DOI: 10.1161/circulationaha.114.014443] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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: 12/03/2014] [Accepted: 08/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Both HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among adults with HIV infection (HIV+). We assessed the association between HIV, depression, and incident HF. METHODS AND RESULTS Veterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (n=81 427: 26 908 HIV+, 54 519 without HIV [HIV-]) were categorized into 4 groups: HIV- without major depressive disorder (MDD) [reference], HIV- with MDD, HIV+ without MDD, and HIV+ with MDD. International Classification of Diseases, Ninth Revision codes from medical records were used to determine MDD and the primary outcome, HF. After 5.8 years of follow-up, HF rates per 1000 person-years were highest among HIV+ participants with MDD (9.32; 95% confidence interval [CI], 8.20-10.6). In Cox proportional hazards models, HIV+ participants with MDD had a significantly higher risk of HF (adjusted hazard ratio, 1.68; 95% CI, 1.45-1.95) compared with HIV- participants without MDD. MDD was associated with HF in separate fully adjusted models for HIV- and HIV+ participants (adjusted hazard ratio, 1.21; 95% CI, 1.06-1.37; and adjusted hazard ratio, 1.29; 95% CI, 1.11-1.51, respectively). Among those with MDD, baseline antidepressant use was associated with lower risk of incident HF events (adjusted hazard ratio, 0.76; 95% CI, 0.58-0.99). CONCLUSIONS Our study is the first to suggest that MDD is an independent risk factor for HF in HIV+ adults. These results reinforce the importance of identifying and managing MDD among HIV+ patients. Future studies must clarify mechanisms linking HIV, MDD, antidepressants, and HF and identify interventions to reduce HF morbidity and mortality in those with both HIV and MDD.
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Affiliation(s)
- Jessica R White
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Chung-Chou H Chang
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Kaku A So-Armah
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Jesse C Stewart
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Samir K Gupta
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Adeel A Butt
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Cynthia L Gibert
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - David Rimland
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Maria C Rodriguez-Barradas
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - David A Leaf
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Roger J Bedimo
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - John S Gottdiener
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Willem J Kop
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Stephen S Gottlieb
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Matthew J Budoff
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Tasneem Khambaty
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Hilary A Tindle
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Amy C Justice
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.)
| | - Matthew S Freiberg
- From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.).
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Wawrzyniak AJ, Dilsizian V, Krantz DS, Harris KM, Smith MF, Shankovich A, Whittaker KS, Rodriguez GA, Gottdiener J, Li S, Kop W, Gottlieb SS. High Concordance Between Mental Stress-Induced and Adenosine-Induced Myocardial Ischemia Assessed Using SPECT in Heart Failure Patients: Hemodynamic and Biomarker Correlates. J Nucl Med 2015. [PMID: 26205303 DOI: 10.2967/jnumed.115.157990] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Mental stress can trigger myocardial ischemia, but the prevalence of mental stress-induced ischemia in congestive heart failure (CHF) patients is unknown. We characterized mental stress-induced and adenosine-induced changes in myocardial perfusion and neurohormonal activation in CHF patients with reduced left-ventricular function using SPECT to precisely quantify segment-level myocardial perfusion. METHODS Thirty-four coronary artery disease patients (mean age±SD, 62±10 y) with CHF longer than 3 mo and ejection fraction less than 40% underwent both adenosine and mental stress myocardial perfusion SPECT on consecutive days. Mental stress consisted of anger recall (anger-provoking speech) followed by subtraction of serial sevens. The presence and extent of myocardial ischemia was quantified using the conventional 17-segment model. RESULTS Sixty-eight percent of patients had 1 ischemic segment or more during mental stress and 81% during adenosine. On segment-by-segment analysis, perfusion with mental stress and adenosine were highly correlated. No significant differences were found between any 2 time points for B-type natriuretic peptide, tumor necrosis factor-α, IL-1b, troponin, vascular endothelin growth factor, IL-17a, matrix metallopeptidase-9, or C-reactive protein. However, endothelin-1 and IL-6 increased, and IL-10 decreased, between the stressor and 30 min after stress. Left-ventricular end diastolic dimension was 179±65 mL at rest and increased to 217±71 after mental stress and 229±86 after adenosine (P<0.01 for both). Resting end systolic volume was 129±60 mL at rest and increased to 158±66 after mental stress (P<0.05) and 171±87 after adenosine (P<0.07), with no significant differences between adenosine and mental stress. Ejection fraction was 30±12 at baseline, 29±11 with mental stress, and 28±10 with adenosine (P=not significant). CONCLUSION There was high concordance between ischemic perfusion defects induced by adenosine and mental stress, suggesting that mental stress is equivalent to pharmacologic stress in eliciting clinically significant myocardial perfusion defects in CHF patients. Cardiac dilatation suggests clinically important changes with both conditions. Psychosocial stressors during daily life may contribute to the ischemic burden of CHF patients with coronary artery disease.
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Affiliation(s)
| | - Vasken Dilsizian
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - David S Krantz
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kristie M Harris
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mark F Smith
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Anthony Shankovich
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kerry S Whittaker
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - John Gottdiener
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland; and
| | - Shuying Li
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland; and
| | - Willem Kop
- Tilburg University, Tilburg, The Netherlands
| | - Stephen S Gottlieb
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland; and
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Palmer JB, Friedman HS, Waltman Johnson K, Navaratnam P, Gottlieb SS. Association of persistent and transient worsening renal function with mortality risk, readmissions risk, length of stay, and costs in patients hospitalized with acute heart failure. Clinicoecon Outcomes Res 2015; 7:357-67. [PMID: 26150730 PMCID: PMC4480591 DOI: 10.2147/ceor.s82267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Data comparing effects of transient worsening renal function (WRFt) and persistent WRF (WRFp) on outcomes in patients hospitalized with acute heart failure (AHF) are lacking. We determined the characteristics of hospitalized AHF patients who experienced no worsening renal function (non-WRF), WRFt, or WRFp, and the relationship between cohorts and AHF-related outcomes. METHODS AND RESULTS A patient's first AHF hospitalization (index) was identified in the Cerner Health Facts(®) database (January 2008-March 2011). Patients had WRF if serum creatinine (SCr) was ≥0.3 mg/dL and increased ≥25% from baseline, and they were designated as WRFp if present at discharge or WRFt if not present at discharge. A total of 55,436 patients were selected (non-WRF =77%, WRFp =10%, WRFt =13%). WRFp had greater comorbidity burden than WRFt. At index hospitalization, WRFp patients had the highest mortality, whereas WRFt patients had the longest length of stay (LOS) and highest costs. These trends were observed at 30, 180, and 365 days postdischarge and confirmed by multivariable analyses. WRF patients had more AHF-related readmissions than non-WRF patients. In sensitivity analyses of the patient subset with live index hospitalization discharges, postdischarge LOS and costs were highest in WRFt patients, whereas mortality associated with a HF hospitalization was significantly higher for WRF patients vs non-WRF patients, with no difference between WRFp and WRFt. CONCLUSION In patients hospitalized for AHF, WRFp was associated with the highest mortality, whereas WRFt was associated with the highest LOS and costs. WRF patients had higher readmissions than non-WRF patients. Transient increases in SCr appear to be associated with detrimental outcomes, especially longer LOS and higher costs.
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Affiliation(s)
| | | | | | | | - Stephen S Gottlieb
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Palmer JB, Friedman H, Waltman Johnson K, Navaratnam P, Gottlieb SS. Abstract 284: Association of Worsening Renal Function With Mortality and Heart Failure Readmissions in Patients Hospitalized With Acute Heart Failure. Circ Cardiovasc Qual Outcomes 2015. [DOI: 10.1161/circoutcomes.8.suppl_2.284] [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: 11/16/2022]
Abstract
Background:
The impact of worsening renal function (WRF) on heart failure (HF)-related readmissions (HFR) and HF-related mortality among hospitalized acute HF patients was examined.
Methods:
A patient’s first acute HF hospitalization event (index) was identified in Cerner Health Facts® database (Jan 2008–March 2011). Patients were categorized as WRF (serum creatinine ≥0.3 mg/dL and ≥25% increase from baseline) persisting at discharge (WRFp), not persisting at discharge (WRFt), or non WRF. Outcomes were compared for the index hospitalization and cumulatively at 30, 180, and 365 days post discharge. Generalized linear model (HFR count) and logistic regression models (mortality) were constructed.
Results:
The acute HF patients (77% [42,507 of 55,436] non WRF, 10% [5,563 of 55,436] WRFp, and 13% [7,366 of 55,436] WRFt) were 53% [29,442 of 55,436] female with a mean age of 72.4 (±14.3) years. WRFp had higher index mortality rates (23.6% [1,312 of 5,563] vs 5.7% [418 of 7,366] vs 3.9% [1,673 of 42,507], P<0.0001) than WRFt and non WRF patients, respectively. For mortality, 70% [3,403 of 4,883] of deaths occurred at the index hospitalization. WRFp and WRFt patients combined had higher 30-day HFR counts than non WRF patients (0.12 vs 0.09, P<0.0001), but there was no difference between WRFp and WRFt. These observations were consistent across all cumulative time points and confirmed by multivariable analyses.
Conclusion:
Acute HF patients with WRF were more likely to die or be readmitted than non WRF patients. WRFp patients experienced higher HF-related mortality rates than WRFt patients but there were no differences in HFR between WRFt and WRFp.
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Tang WW, Dupont M, Hernandez AF, Voors AA, Hsu AP, Felker GM, Butler J, Metra M, Anker SD, Troughton RW, Gottlieb SS, McMurray JJ, Armstrong PW, Massie BM, Califf RM, O’Connor CM, Starling RC. Comparative Assessment of Short-Term Adverse Events in Acute Heart Failure With Cystatin C and Other Estimates of Renal Function. JACC: Heart Failure 2015; 3:40-49. [DOI: 10.1016/j.jchf.2014.06.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/23/2014] [Accepted: 06/30/2014] [Indexed: 01/10/2023]
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Gottlieb SS, Harris K, Todd J, Estis J, Christenson RH, Torres V, Whittaker K, Rebuck H, Wawrzyniak A, Krantz DS. Prognostic significance of active and modified forms of endothelin 1 in patients with heart failure with reduced ejection fraction. Clin Biochem 2014; 48:292-6. [PMID: 25541019 DOI: 10.1016/j.clinbiochem.2014.12.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/26/2014] [Accepted: 12/12/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Concentrations of endothelin I (ET1) are elevated in CHF patients and, like other biomarkers that reflect hemodynamic status and cardiac pathophysiology, are prognostic. The Singulex assay (Sgx-ET1) measures the active form of ET1, with a short in vivo half-life and the Brahms assay measures C-terminal endothelin-1 (CT-ET1), a modified (degraded) product with longer half-life. We aimed to determine the prognostic importance of active and modified forms of endothelin 1 (Singulex and Brahms assays) in comparison with other commonly measured biomarkers of inflammation, hemodynamic status and cardiac physiology in CHF. DESIGN AND METHODS Plasma biomarkers (Sgx-ET1, CT-ET1, NTproBNP, IL-6, TNFα, cTnI, VEGF, hs-CRP, Galectin-3, ST2) were measured in 134 NYHA class II and III CHF patients with systolic dysfunction. Prognostic importance of biomarkers for hospitalization or death were calculated by both logistic regression and Kaplan-Meier survival analyses. RESULTS CT-ET1 (OR=5.2, 95% CI=1.7-15.7) and Sgx-ET1 (OR=2.9, CI=1.1-7.7) were independent predictors of hospitalization and death and additively predicted events after adjusting for age, sex, and other significant biomarkers. Other biomarkers did not improve the model. Similarly, in Cox regression analysis, only CT-ET1 (HR 3.4, 95% CI=1.4-8.4), VEGF (2.7, 95% CI=1.3-5.4), and Sgx-ET1 (HR 2.6, 95% CI=1.2-5.6) were independently prognostic. CONCLUSIONS Elevated concentrations of endothelin 1 predict mortality and hospitalizations in HF patients. Endothelin 1 was more prognostic than commonly obtained hemodynamic, inflammatory, and fibrotic biomarkers. Two different assays of endothelin 1 independently and synergistically were prognostic, suggesting either complementary information or extreme prognostic importance.
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Affiliation(s)
| | - Kristie Harris
- University of Maryland School of Medicine, Baltimore, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | | | | | | | - Kerry Whittaker
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Heather Rebuck
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew Wawrzyniak
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - David S Krantz
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Voors AA, Dahlke M, Meyer S, Stepinska J, Gottlieb SS, Jones A, Zhang Y, Laurent D, Slart RHJA, Navis GJ. Renal hemodynamic effects of serelaxin in patients with chronic heart failure: a randomized, placebo-controlled study. Circ Heart Fail 2014; 7:994-1002. [PMID: 25286914 DOI: 10.1161/circheartfailure.114.001536] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 11/16/2022]
Abstract
BACKGROUND Serelaxin is a promising therapy for acute heart failure. The renal hemodynamic effects of serelaxin in patients with chronic heart failure are unknown. METHODS AND RESULTS In this double-blind, randomized, placebo-controlled, multicenter study, patients with New York Heart Association Class II to III chronic heart failure, left ventricular ejection fraction ≤45%, and estimated glomerular filtration rate (GFR) 30 to 89 mL/min per 1.73 m(2) received intravenous serelaxin 30 μg/kg per day or placebo for 24 hours. Primarily, we assessed the difference between serelaxin and placebo on renal plasma flow (para-aminohippuric acid clearance) and GFR (iothalamate clearance) over 8 to 24 hours. All 22 patients from 1 clinical site were excluded from primary analyses before unblinding because of implausible measurements. The primary analysis comprised 65 patients, mean age was 68 (±10) years, 89% were male, mean estimated GFR was 64 (±19) mL/min per 1.73 m(2), and 34% had New York Heart Association Class III symptoms. Renal plasma flow increased by 29% with serelaxin and 14% with placebo (13% relative increase with serelaxin; P=0.0386), whereas GFR changes did not differ significantly during 8 to 24 hours. Filtration fraction increased by 36% with serelaxin and 62% with placebo (16% relative decrease with serelaxin; P=0.0019) during 8 to 24 hours. Changes in systolic blood pressure were largely similar, and creatinine clearance did not differ between groups. Adverse event rates were similar with serelaxin (20.5%) and placebo (25.0%). CONCLUSIONS In patients with chronic heart failure, serelaxin increased renal plasma flow and reduced the increase in filtration fraction compared with placebo, but did not affect GFR. These results suggest beneficial renal hemodynamic effects in patients with chronic heart failure. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01546532.
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Affiliation(s)
- Adriaan A Voors
- From the University of Groningen, University Medical Center Groningen, The Netherlands (A.A.V., S.M., R.H.J.A.S., G.J.N.); Novartis Pharma AG, Basel, Switzerland (M.D., A.J., D.L.); Institute of Cardiology, Warsaw, Poland (J.S.); University of Maryland, Baltimore (S.S.G.); and Novartis Pharmaceuticals, East Hanover, NJ (Y.Z.).
| | - Marion Dahlke
- From the University of Groningen, University Medical Center Groningen, The Netherlands (A.A.V., S.M., R.H.J.A.S., G.J.N.); Novartis Pharma AG, Basel, Switzerland (M.D., A.J., D.L.); Institute of Cardiology, Warsaw, Poland (J.S.); University of Maryland, Baltimore (S.S.G.); and Novartis Pharmaceuticals, East Hanover, NJ (Y.Z.)
| | - Sven Meyer
- From the University of Groningen, University Medical Center Groningen, The Netherlands (A.A.V., S.M., R.H.J.A.S., G.J.N.); Novartis Pharma AG, Basel, Switzerland (M.D., A.J., D.L.); Institute of Cardiology, Warsaw, Poland (J.S.); University of Maryland, Baltimore (S.S.G.); and Novartis Pharmaceuticals, East Hanover, NJ (Y.Z.)
| | - Janina Stepinska
- From the University of Groningen, University Medical Center Groningen, The Netherlands (A.A.V., S.M., R.H.J.A.S., G.J.N.); Novartis Pharma AG, Basel, Switzerland (M.D., A.J., D.L.); Institute of Cardiology, Warsaw, Poland (J.S.); University of Maryland, Baltimore (S.S.G.); and Novartis Pharmaceuticals, East Hanover, NJ (Y.Z.)
| | - Stephen S Gottlieb
- From the University of Groningen, University Medical Center Groningen, The Netherlands (A.A.V., S.M., R.H.J.A.S., G.J.N.); Novartis Pharma AG, Basel, Switzerland (M.D., A.J., D.L.); Institute of Cardiology, Warsaw, Poland (J.S.); University of Maryland, Baltimore (S.S.G.); and Novartis Pharmaceuticals, East Hanover, NJ (Y.Z.)
| | - Andrew Jones
- From the University of Groningen, University Medical Center Groningen, The Netherlands (A.A.V., S.M., R.H.J.A.S., G.J.N.); Novartis Pharma AG, Basel, Switzerland (M.D., A.J., D.L.); Institute of Cardiology, Warsaw, Poland (J.S.); University of Maryland, Baltimore (S.S.G.); and Novartis Pharmaceuticals, East Hanover, NJ (Y.Z.)
| | - Yiming Zhang
- From the University of Groningen, University Medical Center Groningen, The Netherlands (A.A.V., S.M., R.H.J.A.S., G.J.N.); Novartis Pharma AG, Basel, Switzerland (M.D., A.J., D.L.); Institute of Cardiology, Warsaw, Poland (J.S.); University of Maryland, Baltimore (S.S.G.); and Novartis Pharmaceuticals, East Hanover, NJ (Y.Z.)
| | - Didier Laurent
- From the University of Groningen, University Medical Center Groningen, The Netherlands (A.A.V., S.M., R.H.J.A.S., G.J.N.); Novartis Pharma AG, Basel, Switzerland (M.D., A.J., D.L.); Institute of Cardiology, Warsaw, Poland (J.S.); University of Maryland, Baltimore (S.S.G.); and Novartis Pharmaceuticals, East Hanover, NJ (Y.Z.)
| | - Riemer H J A Slart
- From the University of Groningen, University Medical Center Groningen, The Netherlands (A.A.V., S.M., R.H.J.A.S., G.J.N.); Novartis Pharma AG, Basel, Switzerland (M.D., A.J., D.L.); Institute of Cardiology, Warsaw, Poland (J.S.); University of Maryland, Baltimore (S.S.G.); and Novartis Pharmaceuticals, East Hanover, NJ (Y.Z.)
| | - Gerjan J Navis
- From the University of Groningen, University Medical Center Groningen, The Netherlands (A.A.V., S.M., R.H.J.A.S., G.J.N.); Novartis Pharma AG, Basel, Switzerland (M.D., A.J., D.L.); Institute of Cardiology, Warsaw, Poland (J.S.); University of Maryland, Baltimore (S.S.G.); and Novartis Pharmaceuticals, East Hanover, NJ (Y.Z.)
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Krantz DS, Endrighi R, Waters AJ, Harris KM, Kop WJ, Wawrzyniak AJ, Gottlieb SS. Effects of Acute and Chronic Stress on Heart Failure Functional Status, Hospitalization and Mortality. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.272] [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: 11/17/2022]
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Gottlieb SS, Harris K, Todd J, Estis J, Christenson RH, Torres V, Rebuck H, Whittaker K, Wawrzyniak A, Krantz D. Prognostic Significance of Active and Modified Forms of Endothelin 1 in Patients with Heart Failure with Reduced Ejection Fraction. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.221] [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: 11/17/2022]
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Gottlieb SS, Dilsizian V, Wawrzyniak AJ, Smith M, Harris KM, Whittaker K, Krantz D. Congruity between Mental Stress-Induced and Adenosine-Induced Myocardial Ischemia Assessed Using SPECT in Heart Failure Patients. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.056] [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]
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Palmer JB, Friedman HS, Johnson KW, Navaratnam P, Gottlieb SS. Association of Worsening Renal Function with Length of Stay and Costs in Patients Hospitalized with Acute Heart Failure. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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