Assessing the evidence–practice gap for heart failure in China: the Heart Failure Registry of Patient Outcomes (HERO) study design and baseline characteristics

Introduction: Although the impact of sex on patient outcomes for heart failure (HF) with preserved ejection fraction (HFpEF) has been reported, it is still unclear whether this impact is applicable for elderly patients with HFpEF. This study was conducted as a secondary analysis from a large randomized controlled trial—The Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT)—to evaluate the impact of sex differences on the baseline characteristics and outcomes of HFpEF patients who were older than 70 years.Methods: Baseline characteristic of elderly patients were compared between men and women. Primary outcomes were cardiovascular (CV) mortality and HF-related hospitalization, whereas secondary outcomes were all-cause mortality and all-cause hospitalization. Cox regression models were used to determine the effect of sex differences on patient outcomes.Results: A total of 1,619 patients were included in the study: 898 (55.5%) women and 721 (44.5%) men. Age was similar between women and men. Women had fewer comorbidities but worse cardiac function than men. The rate of primary outcomes was lower in women than in men (18.4 vs. 27.5%; p < 0.001), including rate of CV mortality (8.9 vs. 14.8%; p < 0.001) and HF-related hospitalization (13.4 vs. 18.2%; p = 0.008). All-cause mortality was also lower in women than in men (15.6 vs. 25.4%; p < 0.001). After adjustment for baseline characteristics, Cox regression analysis showed that female sex was a protective factor for CV mortality [hazard ratio (HR): 0.53; 95% confidence interval (CI): 0.40–0.73], HF-related hospitalization (HR: 0.71; 95% CI: 0.55–0.93), and all-cause mortality (HR: 0.59; 95% CI: 0.47–0.75). Although spironolactone significantly reduced the rate of all-cause mortality in women even after adjusting for baseline characteristics (HR: 0.68; 95% CI: 0.48–0.96; p = 0.028), no significant multivariate association was noted between sex and treatment effects (p = 0.190).Conclusion: Among elderly patients with HFpEF, women had worse cardiac function but better survival and lower HF-related hospitalization rate than men.Clinical Trial Registration: NCT00094302 (TOPCAT). Registered October 15, 2004, https://www.clinicaltrials.gov/ct2/show/NCT00094302.

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A statin in the treatment of heart failure? Controlled rosuvastatin multinational study in heart failure (CORONA): Study design and baseline characteristics

European Journal of Heart Failure ◽

10.1016/j.ejheart.2005.09.005 ◽

2005 ◽

Vol 7 (6) ◽

pp. 1059-1069 ◽

Cited By ~ 112

Author(s):

John Kjekshus ◽

Peter Dunselman ◽

Malin Blideskog ◽

Christina Eskilson ◽

Åke Hjalmarson ◽

...

Keyword(s):

Heart Failure ◽

Study Design ◽

Multinational Study ◽

Baseline Characteristics

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Effects of alagebrium, an advanced glycation end-product breaker, in patients with chronic heart failure: study design and baseline characteristics of the BENEFICIAL trial

European Journal of Heart Failure ◽

10.1093/eurjhf/hfp207 ◽

2010 ◽

Vol 12 (3) ◽

pp. 294-300 ◽

Cited By ~ 37

Author(s):

Suzan Willemsen ◽

Jasper W.L. Hartog ◽

Yoran M. Hummel ◽

Jan L. Posma ◽

Leen M. van Wijk ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Study Design ◽

Advanced Glycation ◽

Advanced Glycation End Product ◽

Baseline Characteristics

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Accuracy of Rod Contouring to Desired Angles With and Without a Template: Implications for Achieving Desired Spinal Alignment and Outcomes

Global Spine Journal ◽

10.1177/2192568221998371 ◽

2021 ◽

pp. 219256822199837

Author(s):

Juan Pablo Sardi ◽

Christopher P. Ames ◽

Skye Coffey ◽

Christopher Good ◽

Benny Dahl ◽

...

Keyword(s):

Patient Outcomes ◽

Study Design ◽

Preoperative Planning ◽

Biomechanical Study ◽

Spinal Alignment ◽

Target Angle ◽

Proximal Junctional Failure ◽

Bend Angles

Study Design: Biomechanical Study. Objective: The search for optimal spinal alignment has led to the development of sophisticated formulas and software for preoperative planning. However, preoperative plans are not always appropriately executed since rod contouring during surgery is often subjective and estimated by the surgeon. We aimed to assess whether rods contoured to specific angles with a French rod bender using a template guide will be more accurate than rods contoured without a template. Methods: Ten experienced spine surgeons were requested to contour two 125 × 5.5 mm Ti64 rods to 40°, 60° and 80° without templates and then 2 more rods using 2D metallic templates with the same angles. Rod angles were then measured for accuracy and compared. Results: Average angles for rods bent without a template to 40°, 60° and 80° were 60.2°, 78.9° and 97.5°, respectively. Without a template, rods were overbent by a mean of 18.9°. When using templates of 40°, 60° and 80°, mean bend angles were 41.5°, 59.1° and 78.7°, respectively, with an average underbend of 0.2°. Differences between the template and non-template groups for each target angle were all significant (p < 0.001). Conclusions: Without the template, surgeons tend to overbend rods compared to the desired angle, while surgeons improved markedly with a template guide. This tendency to overbend could have significant impact on patient outcomes and risk of proximal junctional failure and warrants further research to better enable surgeons to more accurately execute preoperative alignment plans.

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Adverse clinical outcomes associated with RAAS inhibitor discontinuation: analysis of over 400 000 patients from the UK Clinical Practice Research Datalink (CPRD)

Clinical Kidney Journal ◽

10.1093/ckj/sfab029 ◽

2021 ◽

Author(s):

Toby J L Humphrey ◽

Glen James ◽

Eric T Wittbrodt ◽

Donna Zarzuela ◽

Thomas F Hiemstra

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

Clinical Practice ◽

Clinical Outcomes ◽

Kidney Injury ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Ckd Stage ◽

First Occurrence ◽

Baseline Characteristics

Abstract Background Users of guideline-recommended renin–angiotensin–aldosterone system (RAAS) inhibitors may experience disruptions to their treatment, e.g. due to hyperkalaemia, hypotension or acute kidney injury. The risks associated with treatment disruption have not been comprehensively assessed; therefore, we evaluated the risk of adverse clinical outcomes in RAAS inhibitor users experiencing treatment disruptions in a large population-wide database. Methods This exploratory, retrospective analysis utilized data from the UK’s Clinical Practice Research Datalink, linked to Hospital Episodes Statistics and the Office for National Statistics databases. Adults (≥18 years) with first RAAS inhibitor use (defined as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) between 1 January 2009 and 31 December 2014 were eligible for inclusion. Time to the first occurrence of adverse clinical outcomes [all-cause mortality, all-cause hospitalization, cardiac arrhythmia, heart failure hospitalization, cardiac arrest, advancement in chronic kidney disease (CKD) stage and acute kidney injury] was compared between RAAS inhibitor users with and without interruptions or cessations to treatment during follow-up. Associations between baseline characteristics and adverse clinical outcomes were also assessed. Results Among 434 027 RAAS inhibitor users, the risk of the first occurrence of all clinical outcomes, except advancement in CKD stage, was 8–75% lower in patients without interruptions or cessations versus patients with interruptions/cessations. Baseline characteristics independently associated with increased risk of clinical outcomes included increasing age, smoking, CKD, diabetes and heart failure. Conclusions These findings highlight the need for effective management of factors associated with RAAS inhibitor interruptions or cessations in patients for whom guideline-recommended RAAS inhibitor treatment is indicated.

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