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Shakoor A, Abou Kamar S, Malgie J, Kardys I, Schaap J, de Boer RA, van Mieghem NM, van der Boon RMA, Brugts JJ. The different risk of new-onset, chronic, worsening, and advanced heart failure: A systematic review and meta-regression analysis. Eur J Heart Fail 2024; 26:216-229. [PMID: 37823229 DOI: 10.1002/ejhf.3048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
AIMS Heart failure (HF) is a chronic and progressive syndrome associated with a poor prognosis. While it may seem intuitive that the risk of adverse outcomes varies across the different stages of HF, an overview of these risks is lacking. This study aims to determine the risk of all-cause mortality and HF hospitalizations associated with new-onset HF, chronic HF (CHF), worsening HF (WHF), and advanced HF. METHODS AND RESULTS We performed a systematic review of observational studies from 2012 to 2022 using five different databases. The primary outcomes were 30-day and 1-year all-cause mortality, as well as 1-year HF hospitalization. Studies were pooled using random effects meta-analysis, and mixed-effects meta-regression was used to compare the different HF groups. Among the 15 759 studies screened, 66 were included representing 862 046 HF patients. Pooled 30-day mortality rates did not reveal a significant distinction between hospital-admitted patients, with rates of 10.13% for new-onset HF and 8.11% for WHF (p = 0.10). However, the 1-year mortality risk differed and increased stepwise from CHF to advanced HF, with a rate of 8.47% (95% confidence interval [CI] 7.24-9.89) for CHF, 21.15% (95% CI 17.78-24.95) for new-onset HF, 26.84% (95% CI 23.74-30.19) for WHF, and 29.74% (95% CI 24.15-36.10) for advanced HF. Readmission rates for HF at 1 year followed a similar trend. CONCLUSIONS Our meta-analysis of observational studies confirms the different risk for adverse outcomes across the distinct HF stages. Moreover, it emphasizes the negative prognostic value of WHF as the first progressive stage from CHF towards advanced HF.
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Affiliation(s)
- Abdul Shakoor
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Sabrina Abou Kamar
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jishnu Malgie
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jeroen Schaap
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Robert M A van der Boon
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
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Lee J, Oh O, Park DI, Nam G, Lee KS. Scoping Review of Measures of Comorbidities in Heart Failure. J Cardiovasc Nurs 2024; 39:5-17. [PMID: 37550833 DOI: 10.1097/jcn.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Comorbidities are risk factors for poor clinical outcomes in patients with heart failure. However, no consensus has been reached on how to assess comorbidities related to clinical outcomes in patients with heart failure. OBJECTIVE The aims of this study were to review (1) how comorbidities have been assessed, (2) what chronic conditions have been identified as comorbidities and (3) the rationale for choosing the comorbidity instruments and/or specific comorbidities when exploring clinical outcomes in patients with heart failure. METHODS The clinical outcomes of interest were mortality, hospitalization, quality of life, and self-care. Three electronic databases and reference list searches were used in the search. RESULTS In this review, we included 39 articles using 3 different ways to assess comorbidities in the relationship with clinical outcomes: using an instrument (ie, Charlson Comorbidity Index), disease count, and including individual comorbidities. A total of 90 comorbidities were investigated in the 39 articles; however, definitions and labels for the diseases were inconsistent across the studies. More than half of the studies (n = 22) did not provide a rationale for selecting the comorbidity instruments and/or all of the specific comorbidities. Some of the rationale for choosing the instruments and/or specific comorbidities was inappropriate. CONCLUSIONS We found several issues related to measuring comorbidities when examining clinical outcomes in patients with heart failure. Researchers need to consider these methodological issues when measuring comorbidities in patients with heart failure. Further efforts are needed to develop guidelines on how to choose proper measures for comorbidities.
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Lee KS, Park DI, Lee J, Oh O, Kim N, Nam G. Relationship between comorbidity and health outcomes in patients with heart failure: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:498. [PMID: 37817062 PMCID: PMC10563307 DOI: 10.1186/s12872-023-03527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The prevalence of heart failure (HF) is expected to rise due to increased survivorship and life expectancy of patients with acute heart conditions. Patients with HF and other multiple comorbid conditions are likely to have poor health outcomes. This study aimed to assimilate the current body of knowledge and to provide the pooled effect of HF patients' comorbid conditions on health outcomes. METHODS A systematic search was performed using MEDLINE, EMBASE and CINAHL databases. Observational studies evaluating the relationship between comorbid conditions and the health outcomes of HF were included. The pooled effect sizes of comorbidity on the identified health outcomes were calculated using a random effects model, and the heterogeneity was evaluated using I2 statistics. RESULTS A total of 42 studies were included in this review, and a meta-analysis was performed using the results of 39 studies. In the pooled analysis, the presence of a comorbid condition showed a significant pooled effect size in relation to the prognostic health outcomes: all-cause mortality (HR 1.31; 95% CI 1.18, 1.45), all-cause readmission (HR 1.16; 95% CI 1.09, 1.23), HF-related readmission (HR 1.13; 95% CI 1.05, 1.23), and non-HF-related readmission (HR 1.17; 95% CI 1.07, 1.27). Also, comorbidity was significantly associated with health-related quality of life and self-care confidence. Furthermore, we identified a total of 32 comorbid conditions from included studies. From these, 16 individual conditions were included in the meta-analyses, and we identified 10 comorbid conditions to have negative effects on overall prognostic outcomes: DM (HR 1.16, 95% CI 1.11, 1.22), COPD (HR 1.31, 95% CI 1.23, 1.39), CKD (HR 1.18, 95% CI 1.14, 1.23, stroke (HR 1.25, 95% CI 1.17, 1.31), IHD (HR 1.17, 95% CI 1.11, 1.23), anemia (HR 1.42, 95% CI 1.14, 1.78), cancer (HR 1.17, 95% CI 1.04, 1.32), atrial fibrillation (HR 1.25, 95% CI 1.01, 1.54), dementia (HR 1.19, 95% CI 1.03, 1.36) and depression (HR 1.17, 95% CI 1.04, 1.31). CONCLUSIONS Comorbid conditions have significantly negative pooled effects on HF patient health outcomes, especially in regard to the prognostic health outcomes. Clinicians should carefully identify and manage these conditions when implementing HF interventions to improve prognostic outcomes.
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Affiliation(s)
- Kyoung Suk Lee
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Da-In Park
- Department of Nursing, College of Life Science and Nano Technology, Hannam University, Daejeon, Republic of Korea.
| | - Jihyang Lee
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Oonjee Oh
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Nayoung Kim
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Gyumi Nam
- Seoul National University Hospital, Seoul, Republic of Korea
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López-Vilella R, Jover Pastor P, Donoso Trenado V, Sánchez-Lázaro I, Barge Caballero E, Crespo-Leiro MG, Martínez Dolz L, Almenar Bonet L. Mortality After the First Hospital Admission for Acute Heart Failure, De Novo Versus Acutely Decompensated Heart Failure With Reduced Ejection Fraction. Am J Cardiol 2023; 196:59-66. [PMID: 37088048 DOI: 10.1016/j.amjcard.2023.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/26/2023] [Accepted: 03/12/2023] [Indexed: 04/25/2023]
Abstract
It is not clear to date whether a first admission in heart failure (HF) marks a worse evolution in patients not previously diagnosed with HF ("de novo HF") than those already diagnosed as outpatients ("acutely decompensated HF"). The aim of the study was to analyze whether survival in patients admitted for de novo HF differs from the survival in those admitted for a first episode of decompensation but with a previous diagnosis of HF. This study includes an analysis of 1,728 patients admitted for decompensated HF during 9 years. Readmissions and patients with left ventricular ejection fraction ≥50% were excluded (finally, 524 patients analyzed). We compared de novo HF (n = 186) in patients not diagnosed with HF, although their structural heart disease was defined, versus acutely decompensated HF (n = 338). The clinical profiles in both groups were similar. The de novo HF group more frequently presented with normal right ventricular function, with less presence of severe tricuspid regurgitation. The probability of survival was low in both groups. Thus, the median life in the de novo HF group was 2.1 years and in the acutely decompensated HF group, 3.5 years. There was a lower probability of long-term survival in the de novo HF group (p = 0.035). The variables associated with mortality were age (p <0.0001), ischemic heart disease (p <0.0001), hypertension (p = 0.009), obesity (p = 0.025), diabetes (p = 0.001), and N-terminal pro-brain natriuretic peptide at admission (p <0.0001). A higher glomerular filtration rate was associated with better survival (p = 0.033). De novo HF was associated with a higher mortality than chronic HF with acute decompensation (hazard ratio 1.53, 95% confidence interval 1.03 to 2.27, p = 0.036). In conclusion, the first admission for HF decompensation in patients with no previous diagnosis of HF identifies a subgroup of patients with higher long-term mortality.
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Affiliation(s)
- Raquel López-Vilella
- Heart Failure and Transplant Unit, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain; Cardiology Department, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain.
| | - Pablo Jover Pastor
- Cardiology Department, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain
| | - Víctor Donoso Trenado
- Heart Failure and Transplant Unit, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain; Cardiology Department, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain
| | - Ignacio Sánchez-Lázaro
- Heart Failure and Transplant Unit, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain; Cardiology Department, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Eduardo Barge Caballero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Cardiology Department, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain
| | - María Generosa Crespo-Leiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Cardiology Department, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña (UDC), A Coruña, Spain
| | - Luis Martínez Dolz
- Cardiology Department, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplant Unit, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain; Cardiology Department, University and Polytechnic Hospital La Fe, Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, University of Valencia, Valencia, Spain
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Perea-Armijo J, López-Aguilera J, Sánchez-Prats R, Castillo-Domínguez JC, González-Manzanares R, Ruiz-Ortiz M, Mesa-Rubio D, Anguita-Sánchez M, Perea-Armijo J, López-Aguilera J, Prats RS, Castillo-Dominguez JC, Gonzalez-Manzanares R, Piserra-Lopez A, Rodriguez-Nieto J, Ruiz-Ortiz M, Pericet-Rodriguez C, Delgado-Ortega M, Rodríguez-Almodovar A, Esteban-Martinez F, Crespin-Crespin M, Mesa-Rubio D, Pan-Álvarez OM, Anguita-Sanchez M. Improvement of left ventricular ejection fraction in patients with heart failure with reduced ejection fraction: Predictors and clinical impact. Med Clin (Barc) 2023:S0025-7753(23)00108-2. [PMID: 37019757 DOI: 10.1016/j.medcli.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND A percentage of patients with heart failure with reduced ejection fraction (HFrEF) improve left ventricular ejection fraction (LVEF) in the evolution. This entity, defined for the first time in an international consensus as heart failure with improved ejection fraction (HFimpEF), could have a different clinical profile and prognosis than HFrEF. Our main aim was to analyze the differential clinical profile between the two entities, as well as the mid-term prognosis. MATERIAL-METHODS Prospective study of a cohort of patients with HFrEF who had echocardiographic data at baseline and follow-up. A comparative analysis of patients who improved LVEF with those who did not was made. Clinical, echocardiographic and therapeutic variables were analyzed, and the mid-term impact in terms of mortality and hospital readmissions for HF was assessed. RESULTS Ninety patients were analyzed. Mean age was 66.5(10.4) years, with a male predominance (72.2%). Forty five patients (50%) improved LVEF (Group-1,HFimpEF) and forty five patients (50%) sustained reduced LVEF (Group-2,HFsrEF). The mean time to LVEF improvement in Group-1 was 12.6(5.7) months. Group-1 had a more favorable clinical profile: lower prevalence of cardiovascular risk factors, higher prevalence of de novo HF (75.6% vs. 42.2%; p<0.05), lower prevalence of ischemic etiology (22.2% vs. 42.2%; p<0.05), with less basal dilatation of the left ventricle. At the end of follow-up (mean 19(1) months) Group-1 had a lower hospital readmission rate (3.1% vs. 26.7%; p<0.01), as well as lower mortality (0% vs. 24.4%; p<0.01). CONCLUSION Patients with HFimpEF seem to have a better mid-term prognosis in terms of reduced mortality and hospital admissions. This improvement could be conditioned by the clinical profile of patients HFimpEF.
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Marques I, Ramos RL, Mendonça D, Teixeira L. One-year mortality after hospitalization for acute heart failure: Predicting factors (PRECIC study subanalysis). Rev Port Cardiol 2023:S0870-2551(23)00121-X. [PMID: 36893846 DOI: 10.1016/j.repc.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/07/2022] [Accepted: 07/14/2022] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES One-year mortality after hospitalization for heart failure (HF) is high. This study aims to identify predictive factors of one-year mortality. METHODS This is a retrospective, single-center and observational study. All patients hospitalized for acute HF for one-year were enrolled. RESULTS A total of 429 patients were enrolled, mean age of 79 years. The in-hospital and one-year all-cause mortality rates were 7.9% and 34.3%, respectively. In the univariable analysis, the factors significantly associated with higher one-year mortality risk were: age ≥80 years (odds ratio (OR)=2.05, 95% confidence interval (CI) 1.35-3.11, p=0.001); active cancer (OR=2.93, 95% CI 1.36-6.32, p=0.008); dementia (OR=2.84, 95% CI 1.81-4.47, p<0.001); functional dependency (OR=2.63, 95% CI 1.65-4.19, p<0.001); atrial fibrillation (OR=1.86, 95% CI 1.24-2.80, p=0.004); higher creatinine (OR=2.03, 95% CI 1.29-3.21, p=0.002), urea (OR=2.92, 95% CI 1.95-4.36, p<0.001) and red cell distribution width (RDW; 4thQ OR=5.59, 95% CI 3.03-10.32, p=0.001); and lower hematocrit (OR=0.94, 95% CI 0.91-0.97, p<0.001), hemoglobin (OR=0.83, 95% CI 0.75-0.92, p<0.001) and platelet distribution width (PDW; OR=0.89, 95% CI 0.82-0.97, p=0.005). In the multivariable analysis, the independent predictors of higher one-year mortality risk were: age ≥80 years (OR=2.05, 95% CI 1.21-3.48); active cancer (OR=2.70, 95% CI 1.03-7.01); dementia (OR=2.69, 95% CI 1.53-4.74); higher urea (OR=2.97, 95% CI 1.84-4.80) and RDW (4thQ OR=5.24, 95% CI 2.55-10.76); and lower PDW (OR=0.88, 95% CI 0.80-0.97). CONCLUSIONS Active cancer, dementia, and high values for urea and RDW at admission are predictors of one-year mortality in patients hospitalized for HF. These variables are readily available at admission and can support the clinical management of HF patients.
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Affiliation(s)
- Irene Marques
- Department of Internal Medicine, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal; ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal.
| | - Raquel Lopes Ramos
- Department of Internal Medicine, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
| | - Denisa Mendonça
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal; Department of Population Studies, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal; EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Laetitia Teixeira
- Department of Population Studies, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
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Kim SE, Yoo BS. Treatment Strategies of Improving Quality of Care in Patients With Heart Failure. Korean Circ J 2023; 53:294-312. [PMID: 37161744 PMCID: PMC10172273 DOI: 10.4070/kcj.2023.0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 04/03/2023] Open
Abstract
Heart failure (HF) is a global health problem closely related to morbidity and mortality. As the burden of HF increases, it is necessary to manage and treat this condition well. However, there are differences between real-world practice and guidelines for the optimal treatment for HF. Patient-related, healthcare provider-related, and health system-related factors contribute to poor adherence to optimal care. This review article aims to examine HF treatment patterns and treatment adherence in real-world practice, identify clinical gaps to suggest ways to improve the quality of care for HF and clinical outcomes for patients with HF. Although it is important to optimize treatment based on evidence-based guidelines to the greatest extent, it is known that there is still poor treatment adherence, and many patients do not receive guideline-directed medical therapy, especially at the early stages. To improve medication adherence, qualitative evaluation through performance measurement, as well as education of patients, caregivers and medical staff through a multidisciplinary approach are important.
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Pranata R, Tondas AE, Yonas E, Vania R, Yamin M, Chandra A, Siswanto BB. Differences in clinical characteristics and outcome of de novo heart failure compared to acutely decompensated chronic heart failure - systematic review and meta-analysis. Acta Cardiol 2021; 76:410-420. [PMID: 32252602 DOI: 10.1080/00015385.2020.1747178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Recent evidence showed that the characteristics and outcome of those with de novo heart failure (HF) and acutely decompensated chronic heart failure (ADCHF) were different. We aimed to perform a comprehensive search on the clinical characteristics and outcome of patients with de novo HF and ADCHF. METHODS We performed a comprehensive search on de novo/new onset acute HF vs ADCHF from inception up until December 2019. RESULTS There were 38320 patients from 15 studies. De novo HF were younger and, had less prevalent hypertension, diabetes mellitus, ischaemic heart disease, chronic obstructive pulmonary disease, atrial fibrillation, and history of stroke/transient ischaemic attack compared to ADCHF. Five studies showed a lower NT-proBNP in de novo HF patients, while one study showed no difference. Valvular heart disease as aetiology of heart failure was less frequent in de novo HF, and upon sensitivity analysis, hypertensive heart disease was more frequent in de novo HF. As for precipitating factors, ACS (OR 2.42; I2:89%) was more frequently seen in de novo HF, whereas infection was less frequently (OR 0.69; I2:32%) in ADCHF. De novo HF was associated with a significantly lower 3-month mortality (OR 0.63; I2:91%) and 1-year (OR 0.59; I2:59%) mortality. Meta-regression showed that 1-year mortality did not significantly vary with age (p = .106), baseline ejection fraction (p = .703), or HF reduced ejection fraction (p = .262). CONCLUSION Risk factors, aetiology, and precipitating factors of HF in de novo and ADCHF differ. De novo HF also had lower 1-year mortality and 3-month mortality compared to ADCHF.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Alexander Edo Tondas
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Sriwijaya, Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia
| | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Rachel Vania
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Muhammad Yamin
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Alvin Chandra
- Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Raffaello WM, Henrina J, Huang I, Lim MA, Suciadi LP, Siswanto BB, Pranata R. Clinical Characteristics of De Novo Heart Failure and Acute Decompensated Chronic Heart Failure: Are They Distinctive Phenotypes That Contribute to Different Outcomes? Card Fail Rev 2021; 7:e02. [PMID: 33708417 PMCID: PMC7919682 DOI: 10.15420/cfr.2020.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022] Open
Abstract
Heart failure is currently one of the leading causes of morbidity and mortality. Patients with heart failure often present with acute symptoms and may have a poor prognosis. Recent evidence shows differences in clinical characteristics and outcomes between de novo heart failure (DNHF) and acute decompensated chronic heart failure (ADCHF). Based on a better understanding of the distinct pathophysiology of these two conditions, new strategies may be considered to treat heart failure patients and improve outcomes. In this review, the authors elaborate distinctions regarding the clinical characteristics and outcomes of DNHF and ADCHF and their respective pathophysiology. Future clinical trials of therapies should address the potentially different phenotypes between DNHF and ADCHF if meaningful discoveries are to be made.
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Affiliation(s)
| | - Joshua Henrina
- Siloam Heart Institute, Siloam Hospitals Kebon Jeruk Jakarta, Indonesia
| | - Ian Huang
- Faculty of Medicine, Universitas Pelita Harapan Tangerang, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital Bandung, Indonesia
| | | | | | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita Jakarta, Indonesia
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan Tangerang, Indonesia
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Conde Martel A. Heart and kidneys, poor travel companions from the start of heart failure. Rev Clin Esp 2020; 220:569-570. [PMID: 32098654 DOI: 10.1016/j.rce.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 12/19/2019] [Indexed: 11/25/2022]
Affiliation(s)
- A Conde Martel
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España; Universidad de Las Palmas de Gran Canaria, Las Palmas, España.
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11
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Conde Martel A. Heart and kidneys, poor travel companions from the start of heart failure. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Senni M, Wachter R, Witte KK, Straburzynska-Migaj E, Belohlavek J, Fonseca C, Mueller C, Lonn E, Chakrabarti A, Bao W, Noe A, Schwende H, Butylin D, Pascual-Figal D. Initiation of sacubitril/valsartan shortly after hospitalisation for acutely decompensated heart failure in patients with newly diagnosed (de novo) heart failure: a subgroup analysis of the TRANSITION study. Eur J Heart Fail 2019; 22:303-312. [PMID: 31820537 DOI: 10.1002/ejhf.1670] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/01/2019] [Accepted: 10/11/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Sacubitril/valsartan has shown efficacy and tolerability in patients with heart failure (HF) and reduced ejection fraction (HFrEF) in the ambulatory setting (PARADIGM-HF), and following stabilisation of acutely decompensated HF (ADHF) (PIONEER-HF and TRANSITION). However, data are lacking for the initiation of sacubitril/valsartan in newly diagnosed (de novo) HFrEF. Here, we assess the tolerability of initiating sacubitril/valsartan following ADHF in TRANSITION subgroups of patients with a de novo vs. prior diagnosis of HFrEF. METHODS AND RESULTS TRANSITION randomised 1002 patients to pre- and post-discharge initiation of sacubitril/valsartan (analysis set n = 991, following exclusions for mis-randomisation). In this post-hoc analysis, tolerability to sacubitril/valsartan [proportion of patients achieving target dose (97/103 mg b.i.d.) at 10 weeks post-randomisation], adverse events (AEs) and serious AEs (SAEs) were compared in de novo (n = 286) and prior HFrEF (n = 705) subgroups. More de novo than prior HFrEF patients achieved target dose at Week 10 (56% vs. 45%; relative risk ratio 1.30, 95% confidence interval 1.12-1.52, P < 0.001), and fewer had SAEs and permanent treatment discontinuations. Initiation of sacubitril/valsartan did not prevent the concomitant initiation and up-titration of guideline-directed HF therapies. De novo patients showed faster and greater decreases in N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin-T, and lower rates of HF and all-cause rehospitalisation vs. prior HFrEF. CONCLUSIONS After ADHF, first-line initiation of sacubitril/valsartan in de novo HFrEF, alongside the initiation of other guideline-directed therapies, is feasible and is associated with a better risk-benefit profile than in patients with prior HFrEF. Early intervention with sacubitril/valsartan may be considered to delay disease progression in patients with de novo HFrEF. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02661217.
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Affiliation(s)
- Michele Senni
- Cardiology Division, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany.,Clinic for Cardiology and Pneumology, University Medicine Göttingen, Germany and German Cardiovascular Research Center, partner site Göttingen, Göttingen, Germany
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Jan Belohlavek
- General Teaching Hospital, Charles University in Prague, Prague, Czech Republic
| | - Candida Fonseca
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, CHLO, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Eva Lonn
- McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Weibin Bao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Adele Noe
- Novartis Pharma AG, Basel, Switzerland
| | | | | | - Domingo Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
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Díaz-Molina B, Avanzas P. Insuficiencia cardiaca de novo o agudamente descompensada: las 2 caras de la moneda. Rev Clin Esp 2019; 219:490-491. [DOI: 10.1016/j.rce.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/10/2019] [Indexed: 11/25/2022]
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14
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Díaz-Molina B, Avanzas P. De novo or acutely decompensated heart failure: the 2 sides of the coin. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Miró Ò, García Sarasola A, Fuenzalida C, Calderón S, Jacob J, Aguirre A, Wu DM, Rizzi MA, Malchair P, Haro A, Herrera S, Gil V, Martín-Sánchez FJ, Llorens P, Herrero Puente P, Bueno H, Domínguez Rodríguez A, Müller CE, Mebazaa A, Chioncel O, Alquézar-Arbé A. Departments involved during the first episode of acute heart failure and subsequent emergency department revisits and rehospitalisations: an outlook through the NOVICA cohort. Eur J Heart Fail 2019; 21:1231-1244. [PMID: 31389111 DOI: 10.1002/ejhf.1567] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/02/2019] [Accepted: 06/30/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES We investigated the natural history of patients after a first episode of acute heart failure (FEAHF) requiring emergency department (ED) consultation, focusing on: the frequency of ED visits and hospitalisations, departments admitting patients during the first and subsequent hospitalisations, and factors associated with difficult disease control. METHODS AND RESULTS We included consecutive patients diagnosed with FEAHF (either with or without previous heart failure diagnosis) in four EDs during 5 months in three different time periods (2009, 2011, 2014). Diagnosis was adjudicated by local principal investigators. The clinical characteristics of the index event were prospectively recorded, and all post-discharge ED visits and hospitalisations [related/unrelated to acute heart failure (AHF)], as well as departments involved in subsequent hospitalisations were retrospectively ascertained. 'Uncontrolled disease' during the first year after FEAHF was considered if patients were attended at ED (≥ 3 times) or hospitalised (≥ 2 times) for AHF or died. Overall, 505 patients with FEAHF were included and followed for a mean of 2.4 years. In-hospital mortality was 7.5%. Among 467 patients discharged alive, 288 died [median survival 3.9 years, 95% confidence interval (CI) 3.5-4.4], 421 (90%) revisited the ED (2342 ED visits; 42.4% requiring hospitalisation, 34.0% AHF-related) and 357 (77%) were hospitalised (1054 hospitalisations; 94.1% through ED, 51.4% AHF-related). AHF-related hospitalisations were mainly in internal medicine (28.0%), short-stay unit (26.3%), cardiology (20.8%), and geriatrics (14.1%). Only 47.4% of AHF-related hospitalisations were in the same department as the FEAHF, and internal medicine involvement significantly increased with subsequent hospitalisations (P = 0.01). Uncontrolled disease was observed in 31% of patients, which was independently related to age > 80 years [odds ratio (OR) 1.80, 95% CI 1.17-2.77], systolic blood pressure < 110 mmHg at ED arrival (OR 2.61, 95% CI 1.26-5.38) and anaemia (OR 2.39, 95% CI 1.51-3.78). CONCLUSION In the present aged cohort of AHF patients from Barcelona, Spain, the natural history after FEAHF showed different patterns of hospital department involvement. Advanced age, low systolic blood pressure and anaemia were factors related to uncontrolled disease during the year after debut.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain.,The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network
| | - Ana García Sarasola
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Carolina Fuenzalida
- Emergency Department, Hospital Clínic, 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Sofía Calderón
- Emergency Department, Hospital Clínic, 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alfons Aguirre
- Emergency Department, Hospital del Mar, Barcelona, Spain
| | - Da M Wu
- Emergency Department, Hospital Clínic, 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain.,San Juan Bautista School of Medicine, San Juan de Puerto Rico, Puerto Rico
| | - Miguel A Rizzi
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Pierre Malchair
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Haro
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Herrera
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network
| | - Víctor Gil
- Emergency Department, Hospital Clínic, 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Francisco J Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain.,Centro Nacionalde Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Pere Llorens
- Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Herrero Puente
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
| | - Héctor Bueno
- Centro Nacionalde Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Cardiology Department, Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | | | - Christian E Müller
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network.,Cardiology Department, University Hospital of Basel, Basel, Switzerland
| | - Alexandre Mebazaa
- The GREAT (Global REsearch in Acute cardiovascular conditions Team) Network.,Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases, Prof. C. C. Iliescu, University of Medicine Carol Davila, Bucharest, Romania
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
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