Prediction of acute coronary syndrome, ischemic stroke, and mortality in patients with heart failure: a comparison of CHA2DS2-VASc and AHEAD scores

В обзорной статье собраны современные представления об особенностях диагностики и мониторинга пациентов пожилого и старческого возраста с сердечной недостаточностью и стенокардией. Особое внимание уделено проблеме коморбидности пациентов старше 65 лет, что требует корректирующих действий при стратификации риска и прогнозировании клинических исходов. Отмечена приоритетность неинвазивных диагностических тестов. Рекомендована оценка хрупкости как неотъемлемой части диагностического процесса пациентов с сердечной недостаточностью и стенокардией ввиду чёткой связи с худшим прогнозом с точки зрения качества жизни, госпитализации и смертности. Review is about current information on the features of heart failure and angina diagnosis and monitoring in elderly and senile patients. One of the main problem in patients over 65 years is comorbidity, which requires corrective action in the risk stratiﬁcation and prediction of clinical outcomes. The priority of non-invasive diagnostic tests is noted. Authors of the article recommend frailty as an obligatory part of diagnostic process in patients with heart failure and angina due to a clear connection with the worst prognosis in terms of quality of life, hospitalization and mortality.

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VINCULIN GENE EXPRESSION IN A COHORT OF EGYPTIAN PATIENTS WITH HEART FAILURE INDUCED BY ACUTE CORONARY SYNDROME

ALEXMED ePosters ◽

10.21608/alexpo.2021.70926.1144 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Noha Abdelfattah

Keyword(s):

Gene Expression ◽

Heart Failure ◽

Acute Coronary Syndrome ◽

Coronary Syndrome ◽

Patients With Heart Failure ◽

Egyptian Patients

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Influence of aldosterone antagonists on markers of electrophysiological instability in patients with heart failure with mid-range ejection fraction after ST-segment elevation acute coronary syndrome in the short- and long-term periods

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2020-2652 ◽

2020 ◽

Vol 19 (5) ◽

pp. 2652

Author(s):

L. V. Shekhovtsova ◽

O. А. Osipova ◽

Zh. Yu. Chefranova ◽

I. B. Kovalenko ◽

Yu. A. Lykov ◽

...

Keyword(s):

Heart Failure ◽

Acute Coronary Syndrome ◽

Ejection Fraction ◽

Aldosterone Antagonists ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Patients With Heart Failure ◽

Short And Long Term

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Galectin-3 and the Development of Heart Failure after Acute Coronary Syndrome: Pilot Experience from PROVE IT-TIMI 22

Clinical Chemistry ◽

10.1373/clinchem.2011.174359 ◽

2012 ◽

Vol 58 (1) ◽

pp. 267-273 ◽

Cited By ~ 83

Author(s):

E Wilson Grandin ◽

Petr Jarolim ◽

Sabina A Murphy ◽

Lea Ritterova ◽

Christopher P Cannon ◽

...

Keyword(s):

Heart Failure ◽

Acute Coronary Syndrome ◽

Cardiac Fibrosis ◽

Coronary Syndrome ◽

Patients With Heart Failure ◽

Galectin 3 ◽

Adverse Remodeling ◽

Nested Case Control ◽

The Relationship ◽

Control Study

Abstract BACKGROUND Galectin-3 is a β-galactoside–binding lectin that has been implicated in cardiac fibrosis and remodeling, is increased in models of failure-prone hearts, and has prognostic value in patients with heart failure (HF). The relationship between galectin-3 and the development of HF after acute coronary syndrome (ACS) is unknown. METHODS In a nested case-control study among patients with ACS in PROVE IT-TIMI 22, we identified 100 cases with a hospitalization for new or worsening HF. Controls were matched (1:1) for age, sex, ACS type, and randomized treatment. Serum galectin-3 was measured at baseline (within 7 days post-ACS). RESULTS Patients who developed HF had higher baseline galectin-3 [median 16.7 μg/L (25th, 75th percentile 14.0, 20.6) vs 14.6 μg/L (12.0, 17.6), P = 0.004]. Patients with baseline galectin-3 above the median had an odds ratio of 2.1 (95% CI 1.2–3.6) for developing HF, P = 0.010. Galectin-3 showed a graded relationship with risk of HF. Cases were more likely to have hypertension, diabetes, prior MI, and prior HF; after adjustment for these factors, this graded relationship with galectin-3 quartile and HF remained significant [adjusted OR 1.4 (95% CI 1.1–1.9), P = 0.020]. When BNP was added to the model, the relationship between galectin-3 and HF was attenuated [adjusted OR 1.3 (95% CI: 0.96–1.9), P = 0.08]. CONCLUSIONS The finding that galectin-3 is associated with the risk of developing HF following ACS adds to emerging evidence supporting galectin-3 as a biomarker of adverse remodeling contributing to HF as well as a potential therapeutic target.

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Abstract 3215: Effects of Selective and Non-Selective Beta-Blockers on Cardiovascular Risk in Patients with Heart Failure or Acute Coronary Syndrome: a Meta-Analysis.

Circulation ◽

10.1161/circ.116.suppl_16.ii_723-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Olav R de Peuter ◽

Federico Lussana ◽

Pieter W Kamphuisen

Keyword(s):

Heart Failure ◽

Acute Coronary Syndrome ◽

Cardiovascular Mortality ◽

Beta Blockers ◽

Meta Analysis ◽

Total Mortality ◽

Cochrane Library ◽

Mortality And Morbidity ◽

Coronary Syndrome ◽

Patients With Heart Failure

Background: Guidelines generally recommend the use of beta-blockers in patients with heart failure (HF) and acute coronary syndrome (ACS). It has recently been suggested that non-selective beta-blockers were more effective than selective beta-blockers in HF. However, a better efficacy of different beta-blockers, specifically analyzing total and cardiovascular (CV) mortality and morbidity, in patients with HF or ACS is unclear. Methods: We performed a meta-analysis of randomized controlled trials (RCTs) through Medline, EMBASE, and Cochrane Library databases to identify RCTs comparing selective or non-selective beta-blockers with placebo (29 studies, 31,856 patients), or directly comparing the two different beta-blockers (5 studies, 3,733 patients). Studies were selected using a priori defined criteria and data on study characteristics, study quality and outcomes were abstracted. All included studies had (cardiovascular) mortality as primary or secondary endpoint. Results: In patients with HF non-selective beta-blockers were associated with a reduction in total mortality (RR 0.75, 95%CI 0.61–0.92), and with a non significant decrease in CV mortality. Selective beta-blockers decreased total and CV mortality (RR 0.76, 0.68–0.84 and RR 0.78, 0.66–0.92, respectively). In patients with ACS non-selective beta-blockers were associated with a significant decrease in total mortality (RR 0.73, 0.64–0.82), CV mortality (RR 0.69, 0.60–0.80) and CV morbidity. Selective beta-blockers however had no effect on total mortality (RR 0.88, 0.68–1.15) or CV mortality (RR 0.89, 0.69–1.15). In HF, direct comparison showed a significantly decreased mortality (RR 0.86, 0.78–0.94) for non-selective beta-blockers compared to selective beta-blockers. For ACS, only one study directly compared different beta-blockers. Conclusions: In patients with HF, selective and non-selective beta-blockers seem equally effective in reducing mortality. In patients with ACS, selective beta-blockers had no influence on total and cardiovascular mortality, in contrast to non-selective beta-blockers. This meta-analysis suggests that patients with ACS should specifically be treated with non-selective beta-blockers to reduce total and cardiovascular mortality.

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The “overweight paradox” in the prognosis of acute coronary syndrome for patients with heart failure—A truth for all? A 10-year follow-up study

Maturitas ◽

10.1016/j.maturitas.2017.05.003 ◽

2017 ◽

Vol 102 ◽

pp. 6-12 ◽

Cited By ~ 8

Author(s):

Matina Kouvari ◽

Christina Chrysohoou ◽

Eleptherios Tsiamis ◽

Hara Kosyfa ◽

Lemonia Kalogirou ◽

...

Keyword(s):

Heart Failure ◽

Acute Coronary Syndrome ◽

Coronary Syndrome ◽

Follow Up Study ◽

Patients With Heart Failure

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The Costs and Cardiovascular Benefits in Patients with Peripheral Artery Disease Receiving a Fourth-Generation Synchronous Telehealth Program (Preprint)

10.2196/preprints.24346 ◽

2020 ◽

Author(s):

Jenkuang Lee ◽

Chi-Sheng Hung ◽

Ching-Chang Huang ◽

Ying-Hsien Chen ◽

Hui-Wen Wu ◽

...

Keyword(s):

Heart Failure ◽

Acute Coronary Syndrome ◽

Ischemic Stroke ◽

Lower Risk ◽

Cardiovascular Events ◽

Control Group ◽

Peripheral Artery ◽

Coronary Syndrome ◽

Artery Disease

BACKGROUND Patients with peripheral artery disease (PAD) are at high risk for major cardiovascular events (MACE), including myocardial infarction, stroke, and hospitalization for heart failure. We have previously shown the clinical efficacy of a 4th-generation synchronous telehealth program for some patients, but the costs and cardiovascular benefits of the program for PAD patients remain unknown. OBJECTIVE The telehealth program is now widely used by higher-risk cardiovascular patients to prevent further cardiovascular events. This study investigated whether patients with PAD would also have better cardiovascular outcomes after participating in the 4th-generation synchronous telehealth program. METHODS This was a retrospective cohort study. We screened 5062 patients with cardiovascular diseases who were treated at National Taiwan University Hospital and then enrolled 391 patients with the diagnosis of PAD. Of these patients, 162 took part in the telehealth program, while 229 did not and thus served as control patients. Inverse probability of treatment weighting (IPTW) based on the propensity score was used to mitigate possible selection bias. Follow-up outcomes included heart failure hospitalization (HFH), acute coronary syndrome (ACS), stroke, and all-cause readmission during the 1-year follow-up period and through the last follow-up. RESULTS The mean follow-up duration was 3.1 ± 1.8 years for the patients who participated in the telehealth program and 3.2 ± 1.8 years for the control group. The telehealth program patients exhibited lower risk of ischemic stroke than the control group in the first year after IPTW (0.9% vs. 3.5%; hazard ratio [HR] 0.24, 95% CI 0.07–0.80). The 1-year composite endpoint of vascular accident, including acute coronary syndrome and stroke, was also significantly lower in the telehealth program group after IPTW (2.4% vs. 5.2%; [HR] 0.46, 95% CI 0.21–0.997). At the end of the follow-up, the telehealth program group continued to exhibit a significantly lower rate of ischemic stroke than the control group after IPTW (0.9% vs. 3.5%; [HR] 0.52, 95% CI 0.28–0.93). Furthermore, the medical costs of the telehealth program patients were not higher than those of the control group, whether in terms of outpatient, emergency department, hospitalization, or total costs. CONCLUSIONS The PAD patients who participated in the 4th-generation synchronous telehealth program exhibited lower risk of ischemic stroke events over both mid- and long-term follow-up periods. However, larger scale and prospective randomized clinical trials are needed to confirm our findings.

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Sodium-glucose cotransporter 2 inhibitor versus metformin as first-line therapy in patients with type 2 diabetes mellitus: a multi-institution database study

Cardiovascular Diabetology ◽

10.1186/s12933-020-01169-3 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Tien-Hsing Chen ◽

Yan-Rong Li ◽

Shao-Wei Chen ◽

Yu-Sheng Lin ◽

Chi-Chin Sun ◽

...

Keyword(s):

Heart Failure ◽

Acute Coronary Syndrome ◽

Ischemic Stroke ◽

Line Treatment ◽

Heart Failure Hospitalization ◽

First Line ◽

Coronary Syndrome ◽

First Line Therapy ◽

All Cause Mortality ◽

First Line Treatment

Abstract Background Sodium-glucose co-transporter 2 inhibitors (SGLT2i) has shown evidence of cardiovascular benefit in patients with type 2 diabetes mellitus (T2DM). Currently metformin is the guideline-recommended first-line treatment. We aimed to investigate the benefit of SGLT2i vs metformin as first-line therapy. Methods Electronic medical records from Chang Gung Research Database during 2016–2019 were retrieved for patients with T2DM. Patients aged < 20, not receiving anti-diabetic medication, first-line treatment neither metformin nor SGLT2i were excluded. Primary outcomes were heart failure hospitalization, acute coronary syndrome, ischemic stroke, and all-cause mortality. Patients were followed up for events or December 31, 2019, whichever comes first. Results After exclusion criteria, a total of 41,020 patients with T2DM were eligible for analysis. There were 1100 patients with SGLT2i as first-line and 39,920 patients with metformin as first-line treatment. IPTW was used for propensity score matching. During one year follow-up, the hazard ratio (HR) of patients on SGLT2i as first-line treatment to patients on metformin as first-line treatment were HR 0.47 (95% CI 0.41–0.54, p < 0.0001) in heart failure hospitalization, HR 0.50 (95% CI 0.41–0.61, p < 0.0001) in acute coronary syndrome, HR 1.21 (95% CI 1.10–1.32, p < 0.0001) in ischemic stroke, and HR 0.49 (95% CI 0.44–0.55, p < 0.0001) in all-cause mortality. Conclusions In patients with T2DM, SGLT2i as first-line treatment may be associated with decreased events of heart failure hospitalization, acute coronary syndrome, and all-cause mortality, compared with metformin as first-line treatment. However, there may be an increased events of ischemic stroke using SGLT2i compared to metformin.

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