1
|
Elheet AA, Alosaimi MA, Alalawi WA, Alasmari AA, Alharbi A, Alhumaidan L, Alosaimi RS, Alharthi RA, Kazim HM. Association Between Cardiovascular Disease and Chronic Kidney Disease Prevalence and Characteristics in Saudi Arabia. Cureus 2023; 15:e50205. [PMID: 38192962 PMCID: PMC10772358 DOI: 10.7759/cureus.50205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Cardiovascular disease (CVD), including coronary artery disease (CAD), is a leading global cause of death. Chronic kidney disease (CKD) is a significant risk factor, particularly in data-scarce Saudi Arabia, due to shared risk factors. A study aims to assess the CVD-CKD relationship, identifying clinical characteristics and risk factors to improve prevention and care in this context, filling a knowledge gap in Saudi Arabia's healthcare map. Methodology It is a single-center retrospective study aimed at evaluating the relationship between cardiovascular disease and chronic kidney disease, conducted between January 2023 and October 2023. Data was sourced from patient files using a data sheet based on a previous study. The data was cleaned in MS Excel (Redmond, USA) and analyzed in IBM Corp. Released 2022. IBM SPSS Statistics for Windows, Version 29.0. Armonk, NY: IBM Corp. Results Our study contains predominantly males (61%), aged 61-80 (54.1%), with a normal body mass index (BMI) (<25) (61.5%) and a high prevalence of smoking (72.3%). Diabetes, hypertension, and smoking were prevalent risk factors. The relationship between CAD severity, renal dysfunction, and ejection fraction (EF) was explored, emphasizing the association between declining renal function and more advanced CAD stages, as well as the decline in estimated glomerular filtration rate (eGFR) with decreasing EF. Age, smoking, CAD, and decreasing EF were linked to renal dysfunction, while smoking, stroke history, peripheral vascular disease (PVD), BMI, and decreasing EF were associated with CAD stage severity. Conclusion Our study explored that as CAD severity increases, renal function decreases, showing both CVD and CKD connected with each other, and a similar correlation occurs between decreasing EF and decreasing eGFR, revealing significant associations with various risk factors. Further research is warranted to explore potential interventions aimed at mitigating the synergistic impact of CVD and CKD on patient morbidity and mortality.
Collapse
Affiliation(s)
- Ahmed A Elheet
- Cardiology Department, Alhada Armed Forces Hospital, Taif, SAU
| | | | | | | | - Aeshah Alharbi
- College of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Lama Alhumaidan
- College of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Reuof S Alosaimi
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | | | | |
Collapse
|
2
|
Chioncel O, Davison B, Adamo M, Antohi LE, Arrigo M, Barros M, Biegus J, Čerlinskaitė-Bajorė K, Celutkiene J, Cohen-Solal A, Damasceno A, Diaz R, Edwards C, Filippatos G, Kimmoun A, Lam CSP, Metra M, Novosadova M, Pagnesi M, Pang PS, Ponikowski P, Radu RI, Saidu H, Sliwa K, Voors AA, Takagi K, Ter Maaten JM, Tomasoni D, Cotter G, Mebazaa A. Non-cardiac comorbidities and intensive up-titration of oral treatment in patients recently hospitalized for heart failure: Insights from the STRONG-HF trial. Eur J Heart Fail 2023; 25:1994-2006. [PMID: 37728038 DOI: 10.1002/ejhf.3039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 09/21/2023] Open
Abstract
AIMS To assess the potential interaction between non-cardiac comorbidities (NCCs) and the efficacy and safety of high-intensity care (HIC) versus usual care (UC) in the STRONG-HF trial, including stable patients with improved but still elevated natriuretic peptides. METHODS AND RESULTS In the trial, eight NCCs were reported: anaemia, diabetes, renal dysfunction, severe liver disease, chronic obstructive pulmonary disease/asthma, stroke/transient ischaemic attack, psychiatric/neurological disorders, and malignancies. Patients were classified by NCC number (0, 1, 2 and ≥3). The treatment effect of HIC versus UC on the primary endpoint, 180-day death or heart failure (HF) rehospitalization, was compared by NCC number and by each individual comorbidity. Among the 1078 patients, the prevalence of 0, 1, 2 and ≥3 NCCs was 24.3%, 39.8%, 24.5% and 11.4%, respectively. Achievement of full doses of HF therapies at 90 and 180 days in the HIC was similar irrespective of NCC number. In HIC, the primary endpoint occurred in 10.0%, 16.6%, 13.6% and 26.2%, in those with 0, 1, 2 and ≥3 NCCs, respectively, as compared to 19.1%, 25.4%, 23.3% and 26.2% in UC (interaction-p = 0.80). The treatment benefit of HIC versus UC on the primary endpoint did not differ significantly by each individual comorbidity. There was no significant treatment interaction by NCC number in quality-of-life improvement (p = 0.98) or the incidence of serious adverse events (p = 0.11). CONCLUSIONS In the STRONG-HF trial, NCCs neither limited the rapid up-titration of HF therapies, nor attenuated the benefit of HIC on the primary endpoint. In the context of a clinical trial, the benefit-risk ratio favours the rapid up-titration of HF therapies even in patients with multiple NCCs.
Collapse
Affiliation(s)
- Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine "Carol Davila", Bucharest, Romania
| | - Beth Davison
- Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France
- Momentum Research Inc, Durham, NC, USA
- Heart Initiative, Durham, NC, USA
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Laura E Antohi
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine "Carol Davila", Bucharest, Romania
| | - Mattia Arrigo
- Department of Internal Medicine, Stadtspital Zurich, Zurich, Switzerland
| | | | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Kamilė Čerlinskaitė-Bajorė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Alain Cohen-Solal
- Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France
- Department of Cardiology, APHP Nord, Lariboisière University Hospital, Paris, France
| | | | - Rafael Diaz
- Estudios Clínicos Latinoamérica, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | | | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Antoine Kimmoun
- Université de Lorraine, Nancy; INSERM, Défaillance Circulatoire Aigue et Chronique, Service de Médecine Intensive et Réanimation Brabois, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore, Singapore
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Peter S Pang
- Department of Emergency Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Razvan I Radu
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine "Carol Davila", Bucharest, Romania
| | - Hadiza Saidu
- Department of Medicine, Murtala Muhammed Specialist Hospital/Bayero University Kano, Kano, Nigeria
| | - Karen Sliwa
- Division of Cardiology, Department of Medicine, Cape Heart Institute, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Adriaan A Voors
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Koji Takagi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Jozine M Ter Maaten
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Gad Cotter
- Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France
- Momentum Research Inc, Durham, NC, USA
- Heart Initiative, Durham, NC, USA
| | - Alexandre Mebazaa
- Université Paris Cité, INSERM UMR-S 942(MASCOT), Paris, France
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, FHU PROMICE, DMU Parabol, APHP Nord, Paris, France
| |
Collapse
|
3
|
Cox ZL, Zalawadiya SK, Simonato M, Redfors B, Zhou Z, Kotinkaduwa L, Zile MR, Udelson JE, Lim DS, Grayburn PA, Mack MJ, Abraham WT, Stone GW, Lindenfeld J. Guideline-Directed Medical Therapy Tolerability in Patients With Heart Failure and Mitral Regurgitation: The COAPT Trial. JACC. HEART FAILURE 2023:S2213-1779(23)00139-7. [PMID: 37115135 DOI: 10.1016/j.jchf.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial, a central committee of heart failure (HF) specialists optimized guideline-directed medical therapies (GDMT) and documented medication and goal dose intolerances before patient enrollment. OBJECTIVES The authors sought to assess the rates, reasons, and predictors of GDMT intolerance in the COAPT trial. METHODS Baseline use, dose, and intolerances of angiotensin-converting enzyme inhibitors (ACEIs) angiotensin II receptor blockers (ARBs), angiotensin receptor neprilysin inhibitors (ARNIs), beta-blockers, and mineralocorticoid receptor antagonists (MRAs) were analyzed in patients with left ventricular ejection fraction (LVEF) ≤40%, in whom maximally tolerated doses of these agents as assessed by an independent HF specialist were required before enrollment. RESULTS A total of 464 patients had LVEF ≤40% and complete medication information. At baseline, 38.8%, 39.4%, and 19.8% of patients tolerated 3, 2, and 1 GDMT classes, respectively (any dose); only 1.9% could not tolerate any GDMT. Beta-blockers were the most frequently tolerated GDMT (93.1%), followed by ACEIs/ARBs/ARNIs (68.5%), and then MRAs (55.0%). Intolerances differed by GDMT class, but hypotension and kidney dysfunction were most common. Goal doses were uncommonly achieved for beta-blockers (32.3%) and ACEIs/ARBs/ARNIs (10.2%) due to intolerances limiting titration. Only 2.2% of patients tolerated goal doses of all 3 GDMT classes. CONCLUSIONS In a contemporary trial population with HF, severe mitral regurgitation, and systematic HF specialist-directed GDMT optimization, most patients had medical intolerances prohibiting 1 or more GDMT classes and achieving goal doses. The specific intolerances noted and methods used for GDMT optimization provide important lessons for the implementation of GDMT optimization in future clinical trials. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] [COAPT]; NCT01626079).
Collapse
Affiliation(s)
- Zachary L Cox
- Lipscomb University College of Pharmacy, Nashville, Tennessee, USA; Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Sandip K Zalawadiya
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matheus Simonato
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Bjorn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Zhipeng Zhou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Lak Kotinkaduwa
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Michael R Zile
- Medical University of South Carolina, RJH Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - James E Udelson
- Division of Cardiology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Michael J Mack
- Department of Cardiovascular Surgery, Baylor Scott and White Health, Plano, Texas, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - JoAnn Lindenfeld
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
4
|
Perreault S, Schnitzer ME, Disso E, Qazi J, Boivin-Proulx LA, Dorais M. Polypharmacy and risk of mortality among patients with heart failure following hospitalization: a nested case-control study. Sci Rep 2022; 12:19963. [PMID: 36402903 PMCID: PMC9675839 DOI: 10.1038/s41598-022-24285-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022] Open
Abstract
Heart failure (HF) is associated with morbidity, rehospitalization and polypharmacy. The incidence rate of mortality in HF patients with polypharmacy is poorly studied. We examine the association of polypharmacy with mortality risk in incident hospitalized HF patients with a primary diagnosis after discharge from the hospital using Quebec administrative databases, Canada from 1999 to 2015. Polypharmacy, cardiovascular (CV) polypharmacy and non-CV polypharmacy were respectively defined as exposure to ≥ 10 drugs, ≥ 5 CV drugs and ≥ 5 non-CV drugs within three months prior to the case or the control selection date. We conducted a nested case-control study to estimate rate ratios (RR) of all-cause mortality using a multivariate conditional logistic regression during one-year of follow-up. We identified 12,242 HF patients with a mean age of 81.6 years. Neither CV polypharmacy (RR 0.97, 95%CI 0.82-1.15) nor non-CV polypharmacy (RR 0.93, 95%CI 0.77-1.12) were associated with lower mortality risk. However, all polypharmacy (RR 1.31, 95%CI 1.07-1.61) showed an association with mortality risk. Myocardial infarction, valvular disease, peripheral artery disease, diabetes, major bleeding, chronic kidney disease, high comorbidity score, high Frailty score, hydralazine and spironolactone users were associated with increasing mortality risk, ranging from 15 to 61%, while use of angiotensin II inhibitors, beta-blockers, statins, anticoagulant, and antiplatelets were associated with lower risk, ranging from 23 to 32%.
Collapse
Affiliation(s)
- Sylvie Perreault
- grid.14848.310000 0001 2292 3357Faculty of Pharmacy, University of Montreal, Case Postale 6128, Succursale Centre-Ville, Montreal, QC Canada ,grid.14848.310000 0001 2292 3357Chaire Sanofi sur l’Utilisation des Médicaments de l’Université de Montréal, Montreal, Canada ,grid.14848.310000 0001 2292 3357Faculté de Pharmacie, Université de Montréal, Case Postale 6128, Succursale Centre-Ville, Montreal, QC H3C 3J7 Canada
| | - Mireille E. Schnitzer
- grid.14848.310000 0001 2292 3357Faculty of Pharmacy, University of Montreal, Case Postale 6128, Succursale Centre-Ville, Montreal, QC Canada ,grid.14848.310000 0001 2292 3357School of Public Health, University of Montreal, Montreal, QC Canada
| | - Eliane Disso
- grid.14848.310000 0001 2292 3357School of Public Health, University of Montreal, Montreal, QC Canada
| | - Jakub Qazi
- grid.14848.310000 0001 2292 3357Faculty of Pharmacy, University of Montreal, Case Postale 6128, Succursale Centre-Ville, Montreal, QC Canada
| | - Laurie-Anne Boivin-Proulx
- grid.14848.310000 0001 2292 3357Faculty of Medicine, University of Montreal, Montreal, QC Canada ,grid.14848.310000 0001 2292 3357CHUM Research Center, University of Montreal, Montreal, QC Canada
| | - Marc Dorais
- StatSciences Inc., Notre-Dame-de-l’Île-Perrot, QC Canada
| |
Collapse
|
5
|
Prasun MA, Blakeman JR, Vuckovic K, Kim M, Albert N, Stamp KD, Jaarsma T, Riegel B. Perceptions of Changes in Practice Patterns and Patient Care among Heart Failure Nurses During the COVID-19 Pandemic. Heart Lung 2022; 52:152-158. [PMID: 35091263 PMCID: PMC8758339 DOI: 10.1016/j.hrtlng.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/18/2021] [Accepted: 01/10/2022] [Indexed: 12/21/2022]
Abstract
Background The Coronavirus (COVID-19) had a profound impact on the delivery of care in both hospital and outpatient settings across the United States. Patients with heart failure (HF) and healthcare providers had to abruptly adapt. Objective To describe how the COVID-19 pandemic affected practice patterns of HF nurses. Methods Practicing HF nurses completed a cross-sectional, anonymous, web-based survey of perceptions of HF practice. Analyses involved descriptive and comparative statistics. Results Of 171 nurses who completed surveys, outpatient HF visits decreased and 63.2% added telehealth visits. Despite spending about 29 min educating patients during visits, 27.5% of nurses perceived that the pandemic decreased patients’ abilities to provide optimal self-care. Nurses reported decreased ability to collect objective data (62.4%; n = 78), although subjective assessment stayed the same (41.6%; n = 52). Conclusion Nurses’ practice patterns provided insight into patient care changes made during COVID-19. Most core components of HF management were retained, but methods of delivery during the pandemic differed.
Collapse
Affiliation(s)
- Marilyn A Prasun
- Professor and Carle BroMenn Medical Center Endowed Professor, Illinois State University, Mennonite College of Nursing, 111B Edwards Hall, Campus Box 5810, Normal, IL 61790-5810, United States.
| | - John R Blakeman
- Assistant Professor, Illinois State University, Mennonite College of Nursing, Normal, IL, United States
| | - Karen Vuckovic
- Associate Professor, University of Illinois Chicago, College of Nursing, Chicago, IL, United States
| | - MyoungJin Kim
- Professor, Illinois State University, Mennonite College of Nursing, Normal, IL, United States
| | - Nancy Albert
- Associate Chief Nursing Officer, Office of Nursing Research and Innovation, Cleveland Clinic Health System, United States
| | - Kelly D Stamp
- Professor and Chair, Family and Community Nursing Department, Eloise R. Lewis Excellence Professor, UNC Greensboro, School of Nursing, United States
| | - Tiny Jaarsma
- Professor, Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Barbara Riegel
- Professor and Edith Clemmer Steinbright Chair of Gerontology, School of Nursing, Philadelphia, PA, United States
| |
Collapse
|
6
|
Alber NM. Innovations in Heart Failure Wanted. J Card Fail 2021; 27:920-921. [PMID: 34364671 DOI: 10.1016/j.cardfail.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|