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Garred CH, Malmborg M, Malik ME, Zahir D, Christensen DM, Arulmurugananthavadivel A, Fosbøl EL, Gislason G, McMurray JJV, Petrie MC, Andersson C, Køber L, Schou M. Age-specific mortality trends in heart failure over 25 years: a retrospective Danish nationwide cohort study. Lancet Healthy Longev 2024; 5:e326-e335. [PMID: 38705151 DOI: 10.1016/s2666-7568(24)00029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Despite advances in heart failure care reducing mortality in clinical trials, it remains unclear whether real-life cohorts have had similar improvements in life expectancy across the age spectrum. We aimed to investigate how mortality trends changed in patients with heart failure over the past 25 years, stratified by age groups. METHODS Using Danish nationwide registries, we identified patients with new-onset heart failure aged 18-95 years. The 5-year all-cause mortality risk and the absolute risk difference of mortality between patients with heart failure and age-matched and sex-matched heart failure-free controls were assessed using Kaplan-Meier estimates and multivariable Cox regression models. Mortality trends were analysed across five calendar periods (1996-2000, 2001-05, 2006-10, 2011-15, and 2016-20) and three age groups (<65 years, 65-79 years, and ≥80 years). FINDINGS 194 997 patients with heart failure were included. Mortality significantly decreased from 1996-2000 (66% [95% CI 65·5-66·4]) to 2016-20 (43% [42·1-43·4]), with similar results shown in all age groups (<65 years: 35% [33·9-36·1] to 15% [14·6-16·3]; 65-79 years: 64% [63·1-64·5] to 39% [37·6-39·6]; and ≥80 years: 84% [83·1-84·3] to 73% [71·7-73·9]). Adjusted mortality rates supported these associations. The absolute risk difference declined notably in younger age groups (<65 years: 29·9% [28·8-31·0] to 12·7% [12·0-13·4] and 65-79 years: 41·1% [40·3-41·9] to 25·1% [24·4-25·8]), remaining relatively stable in those aged 80 years or older (30·6% [29·9-31·3] to 28% [27·2-28·8]). INTERPRETATION Over 25 years, there has been a consistent decrease in mortality among patients with heart failure across age groups, albeit less prominently in patients aged 80 years or older. Further insight is needed to identify effective strategies for improving disease burden in older patients with heart failure. FUNDING None. TRANSLATION For the Danish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
| | - Morten Malmborg
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | | | - Deewa Zahir
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | | | | | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Science, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Science, University of Copenhagen, Copenhagen, Denmark
| | - John J V McMurray
- School of Cardiovascular and Metabolic Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- School of Cardiovascular and Metabolic Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Charlotte Andersson
- Center for Advanced Heart Disease, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Science, University of Copenhagen, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Science, University of Copenhagen, Copenhagen, Denmark
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Yuan C, He L, Du X, Jiang C, Xia S, Zhao X, Li S, Sang C, Long D, Dong J, Ma C. Impact of age on characteristics, performance measures and outcomes of inpatients for heart failure in Beijing, China. ESC Heart Fail 2023; 10:2990-2997. [PMID: 37528635 PMCID: PMC10567638 DOI: 10.1002/ehf2.14487] [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] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/21/2023] [Accepted: 07/16/2023] [Indexed: 08/03/2023] Open
Abstract
AIMS This study aims to provide representative information on heart failure (HF) patients in China, especially older adults aged ≥75 years. We aim to clarify the age-related discrepancies in performance measures and the modifying effect of age on the impact of HF patients' characteristics on clinical outcomes. METHODS AND RESULTS All HF patients admitted into five tertiary and four secondary hospitals of the Capital Medical University were divided into two groups according to age: 1419 (53.3%) were <75 years, and 1244 (46.7%) were ≥75 years. Older HF patients were more likely to be women, with higher left ventricular ejection fraction, with co-morbidities including chronic obstructive pulmonary disease/asthma, anaemia, chronic kidney disease, stroke/transient ischemic attack (TIA), atrial fibrillation/atrial flutter, hypertension, and coronary artery disease, while obesity, diabetes mellitus, hypercholesterolaemia and valvular heart disease were more prevalent among younger HF patients. Left ventricular ejection fraction assessment was performed in a similar proportion of patients in the younger and older groups (81.7% vs. 80.5%, P = 0.426), while B-type natriuretic peptide/N terminal pro brain natriuretic peptide was tested in a lower proportion in the younger group (84.8% vs. 89%, P = 0.001). At discharge, HF with reduced ejection fraction patients were less likely to receive beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, or combined beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers therapy in the older group (49.74% vs. 63.2%, P = 0.002; 52.9% vs. 64.7%, P = 0.006; and 28.57% vs. 45.5%, P < 0.001, respectively) but were equally likely to receive mineralocorticoid receptor antagonists in the two age groups (80.8% vs. 84.1%, P = 0.322). Older patients with HF had higher risk of in-hospital and 1 year mortality (2.7% vs. 1.3%, P = 0.011; 21.7% vs. 12.5%; P < 0.001, respectively). Higher body mass index was associated with better outcomes in both age groups. New York Heart Association functional class IV and estimated glomerular filtration rate < 60 mL/min/1.73 m2 were independent predictors of 1 year mortality. The associations between patients' characteristics and risk of mortality were not modified by age. CONCLUSIONS HF patients aged ≥75 years had distinct clinical profiles, received worse in-hospital therapies and experienced higher in-hospital and 1 year mortality.
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Affiliation(s)
- Cong Yuan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
- The Affiliated Changsha Hospital of Xiangya School of MedicineCentral South UniversityChangshaChina
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
- Heart Health Research CenterBeijingChina
- The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
| | - Chao Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - Shi‐Jun Xia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - Song‐Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - Cai‐Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - De‐Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - Jian‐Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
| | - Chang‐Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesBeijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesBeijingChina
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Szabo TM, Nagy EE, Kirchmaier Á, Heidenhoffer E, Gábor-Kelemen HL, Frăsineanu M, Frigy A. Association of Depression and Anxiety with Cardiac Structural and Functional Characteristics in Heart Failure with Reduced and Mildly Reduced Ejection Fraction. Clin Pract 2023; 13:398-409. [PMID: 36961061 PMCID: PMC10037637 DOI: 10.3390/clinpract13020036] [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] [Received: 01/26/2023] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
Heart failure and mental health conditions frequently coexist and have a negative impact on health-related quality of life and prognosis. We aimed to evaluate depression and anxiety symptoms and to determine the association between psychological distress and cardiac parameters in heart failure with reduced and mildly reduced ejection fraction. A total of 43 patients (33 male, mean age 64 ± 10 years) with heart failure and left ventricular systolic dysfunction (29 with HFrEF, 14 with HFmrEF) underwent comprehensive echocardiographic evaluation. All study participants completed questionnaires for the assessment of depression (PHQ-9), anxiety (GAD-7), and health-related quality of life (MLHFQ). Ten (34%) patients with HFrEF and two (14%) participants with HFmrEF had moderate-to-severe depression symptoms. Significant anxiety symptoms were more frequent in HFrEF (10 vs. 2 patients; 34% vs. 14%). Poor quality of life was also more common among patients with HFrEF (17 vs. 5 patients; 59% vs. 36%), showing higher MLHFQ scores (p = 0.009). Moreover, PHQ-9, GAD-7, and MLHFQ scores showed significant correlations between NYHA class severity and the presence of peripheral edema. The symptoms of dyspnea correlated with both PHQ-9 and MLHFQ scores. Significant correlations were observed between MLHFQ scores and a large number of clinical features, such as exercise capacity, 6MWT distance, the need for furosemide, echocardiographic parameters (LVEDVI, LVESVI, LVEF, LVGLS, SVI), and laboratory variables (albumin, GFR, NT-proBNP). In the multiple linear regression analysis, dyspnea proved to be a significant predictor of higher PHQ-9 and MLHFQ scores, even after adjusting for potential confounders. High symptom burden due to psychological distress is common among patients with HFrEF and HFmrEF. More efficient control of congestion may improve depression, anxiety symptoms, and health-related quality of life.
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Affiliation(s)
- Timea Magdolna Szabo
- Department of Biochemistry and Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania
| | - Előd Ernő Nagy
- Department of Biochemistry and Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania
- Laboratory of Medical Analysis, Clinical County Hospital Mureș, 540394 Târgu Mureș, Romania
| | - Ádám Kirchmaier
- Department of Cardiology, Clinical County Hospital Mureș, 540103 Târgu Mureș, Romania
| | - Erhard Heidenhoffer
- Department of Cardiology, Clinical County Hospital Mureș, 540103 Târgu Mureș, Romania
| | | | - Marius Frăsineanu
- Department of Cardiology, Clinical County Hospital Mureș, 540103 Târgu Mureș, Romania
| | - Attila Frigy
- Department of Cardiology, Clinical County Hospital Mureș, 540103 Târgu Mureș, Romania
- Department of Internal Medicine IV, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540103 Târgu Mureș, Romania
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Guo S, Luo X, Yin X, Yang Y, Yang L. Interaction of HSP70-2 gene polymorphism with body mass index and alcohol consumption on the prognosis of Uyghur patients with ischemic heart failure. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 52:101-109. [PMID: 37283123 PMCID: PMC10407985 DOI: 10.3724/zdxbyxb-2022-0502] [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] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/22/2022] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To investigate the interaction of HSP70-2 gene polymorphism with body mass index (BMI) and alcohol consumption on the prognosis of Uyghur patients with ischemic heart failure (IHF). METHODS A total of 205 Uyghur patients with IHF admitted in Urumqi Friendship Hospital from June 2014 to June 2017 were enrolled; 200 age and sex-matched healthy Uyghur physical examiners in the hospital were enrolled as healthy controls. The HSP70-2 gene +1267 polymorphism was detected by PCR. Multivariate unconditional logistic regression was used to analyze the risk factors associated with prognosis in patients with IHF, and the relative excess risk of interaction (RERI) was calculated by crossover analysis to determine the interaction of HSP70-2 gene polymorphism with BMI and alcohol consumption. RESULTS Patients were followed up for 3 years, there were 56 cases with poor prognosis (27.32%) and 149 cases with good prognosis (72.68%). Compared with the healthy control group and the good prognosis group, the poor prognosis group had a significantly higher proportion of subjects with alcohol consumption, abnormal alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels as well as lower BMI and left ventricular ejection fraction (all P<0.05). There were significant differences in distributions of HSP70-2 genotype AA/AG/GG and A/G allele between the good prognosis group and the poor prognosis group (both P<0.05). There were significant differences in the distribution of HSP70-2 genotype (χ2=45.42, P<0.01) and A/G allele among IHF patients with different NYHA cardiac function class; the frequency of A allele of HSP70-2 gene increased, and G allele decreased with the increase of cardiac function class (χ2=19.14, P<0.01). Multivariate logistic regression analysis showed that alcohol consumption as well as abnormal ALT and AST were risk factors for poor prognosis in patients with IHF, while BMI and GG type of HSP70-2 gene (compared with AA type) were protective factors (all P<0.05). Crossover analysis showed a significant additive interaction between BMI and HSP70-2 gene polymorphism (RERI=1.15, 95%CI: 0.54-1.76, P<0.01), and for patients carrying HSP70-2 gene type AA/AG, BMI<26.5 kg/m2 increased the risk of poor prognosis (OR=7.47, 95%CI: 2.51-22.22, P<0.01); there was no significant additive interaction between alcohol consumption and HSP70-2 gene polymorphism (RERI=0.56, 95%CI: -6.07-7.20, P>0.05). CONCLUSIONS The HSP70-2 gene polymorphism interacts with BMI in Uyghur IHF patients, and BMI<26.5 kg/m2 increases the risk of poor prognosis in IHF patients carrying the HSP70-2 AA/AG genotype.
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Affiliation(s)
- Shuli Guo
- School of Public Health, Hangzhou Normal University, Hangzhou 311100, China.
- Clinical Laboratory Center, Xinjiang Uygur Autonomous Region People's Hospital, Urumqi 830000, China.
| | - Xiandao Luo
- The Third Department of Cardiology, Urumqi Friendship Hospital, Urumqi 830049, China.
| | - Xiaoyu Yin
- School of Public Health, Hangzhou Normal University, Hangzhou 311100, China
| | - Yining Yang
- Department of Cardiology, Xinjiang Uygur Autonomous Region People's Hospital, Urumqi 830000, China
| | - Lei Yang
- School of Public Health, Hangzhou Normal University, Hangzhou 311100, China.
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Zhao J, Xie W, Ye S, Zhang S, Shi W, Cui M, Wang L. The clinical value of the Controlling Nutritional Status score for predicting prognosis in systolic heart failure cases in the vulnerable phase. Front Nutr 2023; 10:1084107. [PMID: 36824173 PMCID: PMC9941137 DOI: 10.3389/fnut.2023.1084107] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Background Malnutrition, a commonly encountered complication of heart failure, has an association with poor prognosis. The vulnerable phase of heart failure constitutes the most vulnerable stage of heart failure cases after discharge (usually within 3 months). At present, the prognostic value of Controlling Nutritional Status (CONUT) score in the vulnerable phase of systolic heart failure is unclear. Methods Totally 187 systolic heart failure cases were retrospectively assessed at the Second Affiliated Hospital of Dalian Medical University. Based on CONUT score at admission, cases were assigned to 3 groups, including the normal nutrition, and mild and moderate or severe malnutrition groups. The primary endpoint was all-cause death in the 90 days following discharge. The secondary, composite outcome encompassed all-cause death and rehospitalization due to heart failure. Kaplan-Meier method and log-rank test were performed to compare outcome event rates between groups. The independent risk factors for outcome events were obtained by multivariate COX regression analysis. The receiver operating characteristic (ROC) curve analysis and the Delong test were used to compare the prediction performance of the CONUT score and other independent risk factors for all-cause death. Results During the 90 days of follow-up, 8.6% of HF patients had the primary endpoint and 23.5% had the secondary outcome. All-cause mortality was markedly elevated in the moderate or severe malnutrition group (Logrank: p < 0.001). Compared with the normal nutrition group, composite endpoint events had starkly increased incidence rates in both malnutrition groups, and the incidence increased with the severity of malnutrition (Logrank: p < 0.05). Multivariate COX risk analysis revealed higher CONUT score [hazard ratio (HR) = 1.791, 95% confidence interval (CI) 1.379-2.327], age (HR = 1.08, 95% CI 1.028-1.134), B-type natriuretic peptide (BNP) (HR = 1.001, 95% CI 1.000-1.001), and aspartate aminotransferase (AST) (HR = 1.008, 95% CI 1.001-1.015) at admission as independent predictive factors of all-cause mortality. And higher CONUT score (HR = 1.162, 95% CI 1.024-1.318) and lower estimated glomerular filtration rate (eGFR) (HR = 0.98, 95% CI 0.966-0.993) for the secondary endpoint. The addition of the CONUT score significantly increased the predictive performance of age, BNP and AST, as well as their combination for all-cause death (Delong test: all p < 0.05). Conclusion The CONUT score at admission independently predicts poor prognosis during the vulnerable phase in patients with systolic heart failure and may be combined with conventional risk factors to further improve the predictive efficacy.
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Affiliation(s)
- Jinglin Zhao
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Wenli Xie
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Suling Ye
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Shenglin Zhang
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Wenyu Shi
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Ming Cui
- Department of Emergency, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China,*Correspondence: Ming Cui,
| | - Lili Wang
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China,Lili Wang,
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Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res 2023; 118:3272-3287. [PMID: 35150240 DOI: 10.1093/cvr/cvac013] [Citation(s) in RCA: 463] [Impact Index Per Article: 463.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/08/2022] [Indexed: 01/25/2023] Open
Abstract
Heart Failure (HF) is a multi-faceted and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. HF affects more than 64 million people worldwide. Therefore, attempts to decrease its social and economic burden have become a major global public health priority. While the incidence of HF has stabilized and seems to be declining in industrialized countries, the prevalence is increasing due to the ageing of the population, improved treatment of and survival with ischaemic heart disease, and the availability of effective evidence-based therapies prolonging life in patients with HF. There are geographical variations in HF epidemiology. There is substantial lack of data from developing countries, where HF exhibits different features compared with that observed in the Western world. In this review, we provide a contemporary overview on the global burden of HF, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Moritz Becher
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Giuseppe M C Rosano
- St George's Hospital Medical School, London, UK.,IRCCS San Raffaele Roma, Rome, Italy
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Cai J, Zhang L, Chen C, Ge J, Li M, Zhang Y, Liu H, Song B. Association between serum Klotho concentration and heart failure in adults, a cross-sectional study from NHANES 2007-2016. Int J Cardiol 2023; 370:236-243. [PMID: 36351541 DOI: 10.1016/j.ijcard.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/08/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Limited data exist on the association between serum Klotho concentration and heart failure (HF). METHODS AND RESULTS We conducted a cross-sectional study of 13,625 participants aged 40-79 years in the National Health and Nutrition Examination Survey (NHANES) 2007-2016. Multivariable logistic regression models were used to examine the association between serum Klotho concentration (ln transformation) and HF. A total of 533 (2.9%) participants were identified to have HF, and participants with the lowest tertiles of serum Klotho concentration had the highest percentage of HF (T1: 3.8% vs. T2: 2.8% and T3: 2.1%, P < 0.001). After adjusting for potential confounders, ln (Klotho) was negatively and independently associated with the risk of HF (OR= 0.55, 95% CI 0.36-0.84). Meanwhile, compared with the T1 group, a higher serum Klotho concentration was associated with a lower risk of HF (tertile 2: OR = 0.93, 95% CI: 0.69-1.29, tertile 3: OR = 0.75, 95% CI: 0.52-1.09, P for trend 0.022). Finally, subgroup analyses indicated that lower Klotho concentrations significantly correlated with an increased risk of HF in half of the subgroups. CONCLUSION Serum Klotho concentration was consistently and negatively associated with the presence of HF among US middle-aged and older adults.
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Affiliation(s)
- Jiasheng Cai
- Departments of Cardiology, Fudan University Zhongshan Hospital, Qingpu Branch, 1158 Park East Road, Shanghai 60518120, China.
| | - Lingyun Zhang
- Department of Nephrology, Huadong Hospital affiliated to Fudan University, 221 Yanan West Road, Shanghai 200040, China.
| | - Conggai Chen
- Department of Stroke Center, the First Affiliated Hospital of Soochow University, 188 Shizi Street Suzhou, Jiangsu Province 215006, China
| | - Jin Ge
- Department of General medicine, Renji Hospital affiliated to JiaoTong University, 1630 Pujian Road, Shanghai 200127, China
| | - Mingxuan Li
- Departments of Cardiology, Fudan University Zhongshan Hospital, Qingpu Branch, 1158 Park East Road, Shanghai 60518120, China
| | - Yi Zhang
- Departments of Cardiology, Fudan University Zhongshan Hospital, Qingpu Branch, 1158 Park East Road, Shanghai 60518120, China
| | - Haibo Liu
- Departments of Cardiology, Fudan University Zhongshan Hospital, Qingpu Branch, 1158 Park East Road, Shanghai 60518120, China.
| | - Bin Song
- Department of Chronic Diseases Management, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou 225001, China.
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Filippatos G, Anker SD, Butler J, Farmakis D, Ferreira JP, Gollop ND, Brueckmann M, Iwata T, Pocock S, Zannad F, Packer M. Effects of empagliflozin on cardiovascular and renal outcomes in heart failure with reduced ejection fraction according to age: a secondary analysis of EMPEROR-Reduced. Eur J Heart Fail 2022; 24:2297-2304. [PMID: 36194680 PMCID: PMC10092219 DOI: 10.1002/ejhf.2707] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 04/14/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS Empagliflozin improves cardiovascular and renal outcomes in patients with heart failure (HF) and reduced ejection fraction (HFrEF), but its efficacy and safety across patient's age is not well established. METHODS AND RESULTS We assessed the effects of empagliflozin (10 mg daily) versus placebo, on top of standard HF therapy, in symptomatic HFrEF patients with a left ventricular ejection fraction ≤40% and increased natriuretic peptides stratified by age (<65, 65-74, ≥75 years). The primary endpoint was a composite of cardiovascular death or HF hospitalization. Key secondary endpoints included first and recurrent HF hospitalizations and slope of change in estimated glomerular filtration rate (eGFR); the latter was supported by an analysis of a renal composite endpoint (chronic dialysis or renal transplantation or profound and sustained reduction in eGFR). Of 3730 patients, 38% were <65 years, 35% were 65-74 years and 27% were ≥75 years. Compared with placebo, empagliflozin reduced the primary endpoint consistently across the three age groups (hazard ratio 0.71 [95% confidence interval 0.57-0.89] for <65 years, 0.72 [0.57-0.93] for 65-74 years, 0.86 [0.67-1.10] for ≥75 years, interaction p-trend test = 0.24). The effects of empagliflozin were also consistent across age groups for key secondary endpoints of first and recurrent HF hospitalization (p-trend = 0.30), the rate of decline in eGFR (p-trend = 0.78) and the renal composite (p-trend = 0.94). Adverse events (AEs), serious AEs and AEs leading to drug discontinuation increased with age in both treatment arms, but empagliflozin did not increase their incidence over placebo within each age group. CONCLUSION The efficacy and safety of empagliflozin in improving cardiovascular and renal outcomes in HFrEF was consistent across the spectrum of age, including older patients (aged ≥75).
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Affiliation(s)
- Gerasimos Filippatos
- Second Department of CardiologyAthens University Hospital Attikon, National and Kapodistrian University of Athens Medical SchoolAthensGreece
| | - Stefan D. Anker
- Department of Cardiology, Berlin Institute of Health Center for Regenerative Therapies, German Centre for Cardiovascular Research partner site BerlinCharité Universitätsmedizin BerlinGermany
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA and University of Mississippi Medical CenterJacksonMSUSA
| | | | - João Pedro Ferreira
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques 1433, CHRUNancyFrance
- UnIC@RISE, Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of MedicineUniversity of PortoPortoPortugal
| | | | - Martina Brueckmann
- Boehringer Ingelheim International GmbHIngelheimGermany
- First Department of Medicine, Faculty of Medicine MannheimUniversity of HeidelbergGermany
| | - Tomoko Iwata
- Boehringer Ingelheim Pharma International GmbH & Co. KGBiberachGermany
| | - Stuart Pocock
- Department of Medical StatisticsLondon School of Hygiene & Tropical MedicineLondonUK
| | - Faiez Zannad
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques 1433, CHRUNancyFrance
| | - Milton Packer
- Baylor Heart and Vascular InstituteBaylor University Medical CenterDallasTXUSA
- Imperial CollegeLondonUK
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9
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Nikhanj A, Kashyap N, Wang K, Phan CL, Siddiqi ZA, Becher H, Oudit GY. Trajectory of left ventricular ejection fraction in response to therapies in patients with muscular dystrophy. Echocardiography 2022; 39:1328-1337. [PMID: 36198087 DOI: 10.1111/echo.15460] [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] [Received: 07/10/2022] [Revised: 08/21/2022] [Accepted: 09/09/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Patients with muscular dystrophy (MD) are at elevated risk of serious cardiac complications and clinical assessment is limited due to inherent physical limitations. We assessed the utility of left ventricular ejection fraction (LVEF) derived from transthoracic echocardiogram (TTE) as a prognostic marker for major adverse cardiac events (MACE) in a mixed adult MD cohort. METHODS One hundred and sixty-five MD patients (median age: 36 (interquartile range [IQR]: 23.0-49.0) years; 65 [39.4%] females) were enrolled in our prospective cohort study. Diagnoses included dystrophinopathies (n = 42), limb-girdle MD (n = 31), type 1 myotonic dystrophy (n = 71), and facioscapulohumeral MD (n = 21). Left ventricular ejection fraction, ventricular dimensions at end-diastole and end-systole, and serial measures (n = 124; follow-up period: 2.19 [IQR: 1.05-3.32] years) stratified patients for MACE risk. RESULTS Cardiomyopathy was diagnosed in 60 (36.4%) patients of the broader cohort (median LVEF: 45.0 [IQR: 35.0-50.0] %). Ninety-eight MACE occurred over the 7-year study period. At baseline, patients with a LVEF < 55.0% had a high risk of MACE (adjusted odds ratio: 8.30; 95% confidence interval [CI]: 3.18-21.7), concordant with the analysis of LV dimensions. Forty-one percent of these patients showed an improvement in LVEF with the optimization of medical and device therapies. Relative to patients with preserved LVEF, patients with reduced LVEF were at an elevated risk of MACE (adjusted hazard ratio [aHR]: 7.21; 95% CI: 1.99-26.1), and improved LVEF resulted in comparable outcomes (aHR: 1.84; 95% CI: .49-6.91) associated with optimization of medical and device therapies. Reduction in QRS duration by CRT therapy was associated with an improvement in LVEF (average improvement: 12.8 [± 2.30] %; p = .04). CONCLUSIONS Reduction in LVEF indicates an increased risk of cardiovascular events in patients with MD. Baseline and serial LVEF obtained by TTE can prognosticate patients for MACE and guide clinical management.
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Affiliation(s)
- Anish Nikhanj
- Division of Cardiology, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Niharika Kashyap
- Division of Cardiology, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Kaiming Wang
- Division of Cardiology, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Cecile L Phan
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Zaeem A Siddiqi
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Harald Becher
- Division of Cardiology, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Gavin Y Oudit
- Division of Cardiology, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
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10
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Khodneva Y, Ringel JB, Rajan M, Goyal P, Jackson EA, Sterling MR, Cherrington A, Oparil S, Durant R, Safford MM, Levitan EB. Depressive symptoms, cognitive impairment, and all-cause mortality among REGARDS participants with heart failure. European Heart Journal Open 2022; 2:oeac064. [PMID: 36330357 PMCID: PMC9617474 DOI: 10.1093/ehjopen/oeac064] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/06/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
Abstract
Aims To ascertain whether depressive symptoms and cognitive impairment (CI) are associated with mortality among patients with heart failure (HF), adjusting for sociodemographic, comorbidities, and biomarkers. Methods and results We utilized Medicare-linked data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a biracial prospective ongoing cohort of 30 239 US community-dwelling adults, recruited in 2003-07. HF diagnosis was ascertained in claims analysis. Depressive symptoms were defined as a score ≥4 on the four-item Center for Epidemiological Studies-Depression scale. Cognitive impairment was defined as a score of ≤4 on the six-item screener that assessed three-item recall and orientation to year, month, and day of the week. Sequentially adjusted Cox proportional hazard models were used to estimate the risk of death. We analyzed 1059 REGARDS participants (mean age 73, 48%-African American) with HF; of those 146 (14%) reported depressive symptoms, 136 (13%) had CI and 31 (3%) had both. Over the median follow-up of 6.8 years (interquartile range, 3.4-10.3), 785 (74%) died. In the socio-demographics-adjusted model, CI was significantly associated with increased mortality, hazard ratio 1.24 (95% confidence interval 1.01-1.52), compared with persons with neither depressive symptoms nor CI, but this association was attenuated after further adjustment. Neither depressive symptoms alone nor their comorbidity with CI was associated with mortality. Risk factors of all-cause mortality included: low income, comorbidities, smoking, physical inactivity, and severity of HF. Conclusion Depressive symptoms, CI, or their comorbidity was not associated with mortality in HF in this study. Treatment of HF in elderly needs to be tailored to cognitive status and includes focus on medical comorbidities.
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Affiliation(s)
- Yulia Khodneva
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Joanna Bryan Ringel
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Mangala Rajan
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Parag Goyal
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
- Division of Cardiology, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Elizabeth A Jackson
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Madeline R Sterling
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Andrea Cherrington
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Suzanne Oparil
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Raegan Durant
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Monika M Safford
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, Al 35294, USA
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11
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Huo X, Zhang L, Bai X, He G, Li J, Miao F, Lu J, Liu J, Zheng X, Li J. Impact of Non-cardiac Comorbidities on Long-Term Clinical Outcomes and Health Status After Acute Heart Failure in China. Front Cardiovasc Med 2022; 9:883737. [PMID: 35911556 PMCID: PMC9326097 DOI: 10.3389/fcvm.2022.883737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Individual non-cardiac comorbidities are prevalent in HF; however, few studies reported how the aggregate burden of non-cardiac comorbidities affects long-term outcomes, and it is unknown whether this burden is associated with changes in health status. Aims To assess the association of the overall burden of non-cardiac comorbidities with clinical outcomes and quality of life (QoL) in patients hospitalized for heart failure (HF). Methods We prospectively enrolled patients hospitalized for HF from 52 hospitals in China. Eight key non-cardiac comorbidities [diabetes, chronic renal disease, chronic obstructive pulmonary disease (COPD), anemia, stroke, cancer, peripheral arterial disease (PAD), and liver cirrhosis] were included, and patients were categorized into four groups: none, one, two, and three or more comorbidities. We fitted Cox proportional hazards models to assess the burden of comorbidities on 1-year death and rehospitalization. Results Of the 4,866 patients, 25.3% had no non-cardiac comorbidity, 32.2% had one, 22.9% had two, and 19.6% had three or more in China. Compared with those without non-cardiac comorbidities, patients with three or more comorbidities had higher risks of 1-year all-cause death [heart rate, HR 1.89; 95% confidence interval (CI) 1.48–2.39] and all-rehospitalization (HR 1.35; 95%CI 1.15–1.58) after adjustment. Although all patients with HF experienced a longitudinal improvement in QoL in the 180 days after discharge, those with three or more non-cardiac comorbidities had an unadjusted 11.4 (95%CI −13.4 to −9.4) lower Kansas City Cardiomyopathy Questionnaire (KCCQ) scores than patients without comorbidities. This difference decreased to −6.4 (95%CI −8.6 to −4.2) after adjustment for covariates. Conclusion Among patients hospitalized with HF in this study, a higher burden of non-cardiac comorbidities was significantly associated with worse health-related QoL (HRQoL), increased risks of death, and rehospitalization post-discharge. The findings highlight the need to address the management of comorbidities effectively in standardized HF care.
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12
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OUP accepted manuscript. Rheumatology (Oxford). [DOI: 10.1093/rheumatology/keac072] [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: 11/17/2021] [Revised: 01/23/2022] [Indexed: 11/13/2022] Open
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13
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Albert NM, Tyson RJ, Hill CL, DeVore AD, Spertus JA, Duffy C, Butler J, Patterson JH, Hernandez AF, Williams FB, Thomas L, Fonarow GC. Variation in use and dosing escalation of renin angiotensin system, mineralocorticoid receptor antagonist, angiotensin receptor neprilysin inhibitor and beta-blocker therapies in heart failure and reduced ejection fraction: Association of comorbidities. Am Heart J 2021; 235:82-96. [PMID: 33497697 DOI: 10.1016/j.ahj.2021.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND In patients with heart failure and reduced ejection fraction (HFrEF), angiotensin converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), or angiotensin receptor neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonists (MRA), and beta-blockers (βB) are underutilized. It is unknown if patients with and without comorbidities have similar ACEi/ARB/ARNI, MRA, and βB prescription patterns. METHODS Baseline data from the CHAMP-HF (Change the Management of Patients with Heart Failure) registry were categorized by history of atrial fibrillation, asthma/chronic lung disease, obstructive sleep apnea, and depression. Using multivariate hierarchical logistic models, associations of ACEi/ARB/ARNI, MRA and βB medication use and dose by comorbidities were assessed after adjusting for patient characteristics. RESULTS Of 4,815 HFrEF patients from 152 CHAMP-HF sites, ACEi/ARB/ARNI use was lower in patients with more comorbidities, and generally, MRA use was low and βB use was high. In adjusted analyses, patients with HFrEF and comorbid obstructive sleep apnea, vs. without, were more likely to be prescribed ARNI (OR [95% CI]: 1.25 [1.00, 1.55]); P = .047 and MRA (1.31 [1.11, 1.55]); P = .002 and less likely to be prescribed ACEi (0.74 [0.63, 0.88]); P < .001. Patients with atrial fibrillation, vs. without, were less likely to receive ACEi/ARB (0.82 [0.71, 0.95]); P = .006 and any study medication (0.81 [0.67, 0.97]); P = .020. Comorbid lung disease and history of depression were not associated with HFrEF prescriptions. CONCLUSIONS Renin-angiotensin-aldosterone blockade therapy prescription and dose varied by comorbidity status, but βB therapy did not. In quality efforts, leaders need to consider use and dosing of prescriptions in light of prevalent comorbidities.
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14
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Stubbe B, Seyfarth HJ, Kleymann J, Halank M, Al Ghorani H, Obst A, Desole S, Ewert R, Opitz CF. Monotherapy in patients with pulmonary arterial hypertension at four German PH centres. BMC Pulm Med 2021; 21:130. [PMID: 33882879 PMCID: PMC8061059 DOI: 10.1186/s12890-021-01499-2] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background Although combination therapy is the gold standard for patients with pulmonary arterial hypertension (PAH), some of these patients are still being treated with monotherapy. Methods We conducted a retrospective analysis at four German PH centres to describe the prevalence and characteristics of patients receiving monotherapy. Results We identified 131 incident PAH patients, with a mean age of 64 ± 13.8 years and a varying prevalence of comorbidities, cardiovascular risk factors and targeted therapy. As in other studies, the extent of prescribed PAH therapy varied with age and coexisting diseases, and younger, so-called “typical” PAH patients were more commonly treated early with combination therapy (48% at 4–8 months). In contrast, patients with multiple comorbidities or cardiovascular risk factors were more often treated with monotherapy (69% at 4–8 months). Survival at 12 months was not significantly associated with the number of PAH drugs used (single, dual, triple therapy) and was not different between “atypical” and “typical” PAH patients (89% vs. 85%). Conclusion Although “atypical” PAH patients with comorbidities or a more advanced age are less aggressively treated with respect to combination therapy, the outcome of monotherapy in these patients appears to be comparable to that of dual or triple therapy in “typical” PAH patients.
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Affiliation(s)
- Beate Stubbe
- Internal Medicine B, Pneumology, University Hospital Greifswald, Greifswald, Germany.
| | | | - Janina Kleymann
- Internal Medicine, Pneumology, University Hospital Dresden, Dresden, Germany
| | - Michael Halank
- Internal Medicine, Pneumology, University Hospital Dresden, Dresden, Germany
| | - Hussam Al Ghorani
- Internal Medicine, Cardiology, DRK Kliniken Berlin and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anne Obst
- Internal Medicine B, Pneumology, University Hospital Greifswald, Greifswald, Germany
| | - Susanna Desole
- Internal Medicine B, Pneumology, University Hospital Greifswald, Greifswald, Germany
| | - Ralf Ewert
- Internal Medicine B, Pneumology, University Hospital Greifswald, Greifswald, Germany
| | - Christian F Opitz
- Internal Medicine, Cardiology, DRK Kliniken Berlin and Charité-Universitätsmedizin Berlin, Berlin, Germany
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15
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Cai A, Wu Z, Xu L, Xia S, He X, Zhang Y, Chen J, Zhou Y, Li L. Association of anaemia and all-cause mortality in patients with ischaemic heart failure varies by renal function status. ESC Heart Fail 2021; 8:2270-2281. [PMID: 33838020 PMCID: PMC8120417 DOI: 10.1002/ehf2.13325] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Received: 12/29/2020] [Revised: 02/19/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
Aims The aims of the current study were to evaluate the association between anaemia and all‐cause mortality according to chronic kidney disease (CKD) status and to explore at what level of haemoglobin concentration would the all‐cause mortality risk increase prominently among CKD and non‐CKD patients, respectively. Methods and results This is a prospective cohort study, and 1559 patients with ischaemic heart failure (IHF) were included (mean age of 63.5 ± 11.0 years, 85.8% men) from December 2015 to June 2019. Patients were divided into the CKD (n = 481) and non‐CKD (n = 1078) groups based on the estimated glomerular filtration rate of 60 mL/min/1.73 m2. In the CKD group, the incidence rate of all‐cause mortality in anaemic and non‐anaemic patients was 15.4 per 100 person‐years and 10.8 per 100 person‐years, respectively, with an incidence rate ratio of 1.42 (95% confidence interval: 1.00–2.02; P‐value = 0.05). In the non‐CKD group, the incidence rate of all‐cause mortality in anaemic and non‐anaemic patients was 9.8 per 100 person‐years and 5.5 per 100 person‐years, respectively, with an incidence rate ratio of 1.78 (95% confidence interval: 1.20–2.59; P‐value = 0.005). After a median follow‐up of 2.1 years, the cumulative incidence rate of all‐cause mortality in anaemic and non‐anaemic patients was 41.5% and 44.1% (P‐value = 0.05) in the CKD group, and 30.9% and 18.1% (P‐value < 0.0001) in the non‐CKD group. In the CKD group, cumulative incidence rate of all‐cause mortality increased prominently when haemoglobin concentration was below 100 g/L, which was not observed in the non‐CKD group. Conclusions Results of the current study indicated that among IHF patients, the association between anaemia and all‐cause mortality differed by the renal function status. These findings underline the importance to assess mortality risk and manage anaemia among IHF patients according to the renal function status.
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Affiliation(s)
- Anping Cai
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Zejia Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Lan Xu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Shuang Xia
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xuyu He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Ying Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Liwen Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
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Rohde LE, Claggett BL, Wolsk E, Packer M, Zile M, Swedberg K, Rouleau J, Pfeffer MA, Desai AS, Lund LH, Kober L, Anand I, Merkely B, Senni M, Shi V, Rizkala A, Lefkowitz M, McMurray JJV, Solomon SD. Cardiac and Noncardiac Disease Burden and Treatment Effect of Sacubitril/Valsartan: Insights From a Combined PARAGON-HF and PARADIGM-HF Analysis. Circ Heart Fail 2021; 14:e008052. [PMID: 33706551 DOI: 10.1161/circheartfailure.120.008052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/06/2023]
Abstract
BACKGROUND The net clinical benefit of cardiac disease-modifying drugs might be influenced by the interaction of different domains of disease burden. We assessed the relative contribution of cardiac, comorbid, and demographic factors in heart failure (HF) and how their interplay might influence HF prognosis and efficacy of sacubitril/valsartan across the spectrum of left ventricular ejection fraction. METHODS We combined data from 2 global trials that evaluated the efficacy of sacubitril/valsartan compared with a renin-angiotensin antagonist in symptomatic HF patients (PARADIGM-HF [Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With an Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure; n=8399] and PARAGON-HF [Prospective Comparison of Angiotensin-Converting Enzyme Inhibitor With Angiotensin Receptors Blockers Global Outcomes in Heart Failure With Preserved Ejection Fraction; n=4796]). We decomposed the previously validated Meta-Analysis Global Group in Chronic Heart Failure risk score into cardiac (left ventricular ejection fraction, New York Heart Association class, blood pressure, time since HF diagnosis, HF medications), noncardiac comorbid (body mass index, creatinine, diabetes, chronic obstructive pulmonary disease, smoking), and demographic (age, gender) categories. Based on these domains, an index representing the balance of cardiac to noncardiac comorbid burden was created (cardiac-comorbid index). Clinical outcomes were time to first HF hospitalization or cardiovascular deaths and all-cause mortality. RESULTS Higher scores of the cardiac domain were observed in PARADIGM-HF (10 [7-13] versus 5 [3-6], P<0.001) and higher scores of the demographic domain in PARAGON-HF (10 [8-13] versus 5 [2-9], P<0.001). In PARADIGM-HF, the contribution of the cardiac domain to clinical outcomes was greater than the noncardiac domain (P<0.001), while in PARAGON-HF the attributable risk of the comorbid and demographic categories predominated. Individual scores from each sub-domain were linearly associated with the risk of clinical outcomes (P<0.001). Beneficial effects of sacubitril/valsartan were observed in patients with preponderance of cardiac over noncardiac comorbid burden (cardiac-comorbid index >5 points), suggesting a significant treatment effect modification (interaction P<0.05 for both outcomes). CONCLUSIONS Domains of disease burden are clinically relevant features that influence the prognosis and treatment of patients with HF. The therapeutic benefits of sacubitril/valsartan vary according to the balance of components of disease burden, across different ranges of left ventricular ejection fraction.
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Affiliation(s)
- Luis E Rohde
- Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA (L.E.R., B.L.C., M.A.P., A.S.D., S.D.S.).,Hospital de Clínicas de Porto Alegre and UFRGS Medical School, Brazil (L.E.R.)
| | - Brian L Claggett
- Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA (L.E.R., B.L.C., M.A.P., A.S.D., S.D.S.)
| | - Emil Wolsk
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark (E.W.)
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.).,Imperial College, London, United Kingdom (M.P.)
| | - Michael Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston (M.Z.)
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.)
| | - Jean Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.R.)
| | - Marc A Pfeffer
- Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA (L.E.R., B.L.C., M.A.P., A.S.D., S.D.S.)
| | - Akshay S Desai
- Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA (L.E.R., B.L.C., M.A.P., A.S.D., S.D.S.)
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden (L.H.L.)
| | - Lars Kober
- Department of Cardiology, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (L.K.)
| | - Inder Anand
- Department of Medicine, VA Medical Center and University of Minnesota, Minneapolis (I.A.)
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.)
| | - Michele Senni
- Cardiology Division, Cardiovascular Department, Hospital Papa Giovanni XXIII, Bergamo, Italy (M.S.)
| | - Victor Shi
- Novartis, East Hanover, New Jersey (V.S., A.R., M.L.)
| | - Adel Rizkala
- Novartis, East Hanover, New Jersey (V.S., A.R., M.L.)
| | | | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.)
| | - Scott D Solomon
- Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA (L.E.R., B.L.C., M.A.P., A.S.D., S.D.S.)
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17
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Liu J, Guo Z, Fan M, Liang W, He X, Wu D, Dong Y, Zhu W, Liu C. Major depression and clinical outcomes in patients with heart failure with preserved ejection fraction. Eur J Clin Invest 2021; 51:e13401. [PMID: 32910827 DOI: 10.1111/eci.13401] [Citation(s) in RCA: 3] [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] [Received: 07/23/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Limited data have been published concerning about depression in heart failure with preserved ejection fraction (HFpEF). Besides, among HFpEF patients with depression, the efficacy of antidepressants is poorly defined. Therefore, our current study was aimed to examine the relationship between major depression and clinical outcomes in HFpEF patients and further address the effects of antidepressants on prognosis in patients with major depression and HFpEF. METHODS A total of 1431 patients enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT) were divided into 2 groups according to the baseline depression status. Major depression was diagnosed if the Patient Health Questionnaire-9 score (PHQ-9) ≥ 10. Univariable and multivariable Cox proportional hazards models tested the association of major depression with outcomes and the effects of antidepressants among HFpEF patients with major depression during a follow-up of 6 years. RESULTS 26.7% (382/1431) of patients were diagnosed with major depression. After multivariable adjustment, major depression at baseline was not significantly associated with cardiovascular outcomes (fully adjusted hazard ratio (aHR) 0.95 [0.76-1.18] for primary outcomes; aHR: 0.86 [0.67-1.10] for HF hospitalization; aHR: 1.06 [0.91-1.23] for any hospitalization; aHR: 1.00 [0.70-1.43] for cardiovascular death; aHR: 1.24 [0.96-1.61] for all-cause death). Additionally, among HFpEF patients with major depression, the use of antidepressants was not associated with adverse events (P > .05 for all analyses). CONCLUSIONS In HFpEF patients, major depression at baseline did not increase mortality or rehospitalization. Additionally, treatment with antidepressants might not improve prognosis among HFpEF patients with major depression. Future studies are warranted to explore the effects of antidepressants on HFpEF patients with depression.
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Affiliation(s)
- Jian Liu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China.,Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China
| | - Zejun Guo
- The hospital of South China Normal University, Guangzhou, PR China
| | - Meida Fan
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China.,Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Weihao Liang
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China
| | - Xin He
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China
| | - Dexi Wu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China
| | - Yugang Dong
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, PR China
| | - Wengen Zhu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China
| | - Chen Liu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, PR China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, PR China
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18
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D'Elia E, Stamerra CA, Vecchi A, Duino V, Grosu A, Abete R, Baio P, Gori M, Gavazzi A, Ferri C, Senni M. Association between sleep disordered breathing, neurocognitive impairment and diastolic function in acute heart failure patients: an insight after the vulnerable phase of the hospitalization. Intern Emerg Med 2021; 16:369-377. [PMID: 32557094 DOI: 10.1007/s11739-020-02397-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
Sleep disordered breathing (SDB) and neurocognitive impairment (NI) are a typical feature of HF (heart failure), especially with preserved ejection fraction (HFpEF). So far, very few data exist regarding changes in the severity of SDB, the degree of NI, and the diastolic function in acute HF (AHF) patients and during follow up. In a population of 24 AHF patients (12 with reduced ejection fraction-HFrEF- and 12 HFpEF) with SDB a complete echocardiogram, a set of NI tests, and a polysomnography were performed in the acute phase and after 90 days. A control group of 12 non-HF patients hospitalized for other cardiovascular causes was considered. At baseline, SDB were present both in HFpEF and HFrEF, and a consistent reduction of apneic events was observed at follow up. Improvements in diastolic and right ventricular function were documented at three months compared to baseline, both in HFpEF and in HFrEF. Compared to HFrEF patients and controls, HFpEF patients showed lower NI scores at baseline tests, but a more significant improvement at three months follow-up. In AHF patients with SDB the achievement of a better compensation could lead to important beneficial effect not only on echocardiographic variables and nocturnal respiratory profile, but also on NI, especially in HFpEF.
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Affiliation(s)
- Emilia D'Elia
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy.
| | - Cosimo Andrea Stamerra
- Department of Life, 2 Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea Vecchi
- Cardiovascular Department, Hospital Galmarini, ASST Settelaghi, Tredate, Italy
| | - Vincenzo Duino
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| | - Aurelia Grosu
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| | - Raffaele Abete
- Policlinico Di Monza, Monza, Italy
- Pavia University, Pavia, Italy
| | - Pierangelo Baio
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| | - Mauro Gori
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| | | | - Claudio Ferri
- Department of Life, 2 Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
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19
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Sbolli M, Fiuzat M, Cani D, O'Connor CM. Depression and heart failure: the lonely comorbidity. Eur J Heart Fail 2020; 22:2007-2017. [DOI: 10.1002/ejhf.1865] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Marco Sbolli
- University of Brescia Brescia Italy
- Inova Heart and Vascular Institute Fairfax VA USA
| | | | - Dario Cani
- University of Brescia Brescia Italy
- Inova Heart and Vascular Institute Fairfax VA USA
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