scholarly journals No substantial excess all-cause mortality among cardiac implantable electronic device patients during the first COVID‑19 lockdown in the Leiden area

2022 ◽  
Author(s):  
M. Feijen ◽  
A. D. Egorova ◽  
E. T. van der Velde ◽  
M. J. Schalij ◽  
S. L. M. A. Beeres
Keyword(s):  
Excess Mortality ◽  
Electronic Device ◽  
Cardiac Implantable Electronic Device ◽  
Strict Adherence ◽  
Chronic Heart Disease ◽  
Vulnerable Patients ◽  
All Cause Mortality ◽  
Complicated Course ◽  
Baseline Characteristics

AbstractIn the Netherlands, the coronavirus disease 2019 (COVID‑19) pandemic has resulted in excess mortality nationwide. Chronic heart disease patients are at risk for a complicated COVID‑19 course. The current study investigates all-cause mortality among cardiac implantable electronic device (CIED) patients during the first peak of the pandemic and compares the data to the statistics for the corresponding period in the two previous years. Data of adult CIED patients undergoing follow-up at the Leiden University Medical Centre were analysed. All-cause mortality between 1 March and 31 May 2020 was evaluated and compared to the data for the same period in 2019 and 2018. At the beginning of the first peak of the pandemic, 3,171 CIED patients (median age 70 years; 68% male; 41% ischaemic aetiology) were alive. Baseline characteristics of the 2019 (n = 3,216) and 2018 (n = 3,169) cohorts were comparable. All-cause mortality during the peak of the pandemic was 1.4% compared to 1.6% and 1.4% in the same period in 2019 and 2018, respectively (p = 0.84). During the first peak of the COVID‑19 pandemic, there was no substantial excess mortality among CIED patients in the Leiden area, despite the fact that this is group at high risk for a complicated course of a COVID‑19 infection. Strict adherence to the preventive measures may have prevented substantial excess mortality in these vulnerable patients.

scholarly journals Clinical characteristics, one-year change in ejection fraction and long-term outcomes in patients with heart failure with mid-range ejection fraction: a multicentre prospective observational study in Catalonia (Spain)

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018719 ◽  
Author(s):  
Nuria Farré ◽  
Josep Lupon ◽  
Eulàlia Roig ◽  
Jose Gonzalez-Costello ◽  
Joan Vila ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Prospective Observational Study ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
End Point ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Baseline Characteristics

ObjectivesThe aim of this study was to analyse baseline characteristics and outcome of patients with heart failure and mid-range left ventricular ejection fraction (HFmrEF, left ventricular ejection fraction (LVEF) 40%–49%) and the effect of 1-year change in LVEF in this group.SettingMulticentre prospective observational study of ambulatory patients with HF followed up at four university hospitals with dedicated HF units.ParticipantsFourteen per cent (n=504) of the 3580 patients included had HFmrEF.InterventionsBaseline characteristics, 1-year LVEF and outcomes were collected. All-cause death, HF hospitalisation and the composite end-point were the primary outcomes.ResultsMedian follow-up was 3.66 (1.69–6.04) years. All-cause death, HF hospitalisation and the composite end-point were 47%, 35% and 59%, respectively. Outcomes were worse in HF with preserved ejection fraction (HFpEF) (LVEF>50%), without differences between HF with reduced ejection fraction (HFrEF) (LVEF<40%) and HFmrEF (all-cause mortality 52.6% vs 45.8% and 43.8%, respectively, P=0.001). After multivariable Cox regression analyses, no differences in all-cause death and the composite end-point were seen between the three groups. HF hospitalisation and cardiovascular death were not statistically different between patients with HFmrEF and HFrEF. At 1-year follow-up, 62% of patients with HFmrEF had LVEF measured: 24% had LVEF<40%, 43% maintained LVEF 40%–49% and 33% had LVEF>50%. While change in LVEF as continuous variable was not associated with better outcomes, those patients who evolved from HFmrEF to HFpEF did have a better outcome. Those who remained in the HFmrEF and HFrEF groups had higher all-cause mortality after adjustment for age, sex and baseline LVEF (HR 1.96 (95% CI 1.08 to 3.54, P=0.027) and HR 2.01 (95% CI 1.04 to 3.86, P=0.037), respectively).ConclusionsPatients with HFmrEF have a clinical profile in-between HFpEF and HFrEF, without differences in all-cause mortality and the composite end-point between the three groups. At 1 year, patients with HFmrEF exhibited the greatest variability in LVEF and this change was associated with survival.

Canadian Registry of Electronic Device Outcomes: remote monitoring outcomes in the Abbott battery performance alert—a multicentre cohort

EP Europace ◽  
2021 ◽  
Author(s):  
Sharath Kumar ◽  
Jason Davis ◽  
Bernard Thibault ◽  
Iqwal Mangat ◽  
Benoit Coutu ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Primary Outcome ◽  
Electronic Device ◽  
Electronic Devices ◽  
Cardiac Resynchronization ◽  
Device Performance ◽  
Cardiac Implantable Electronic Devices ◽  
All Cause Mortality ◽  
Multicentre Cohort

Abstract Aims Cardiac implantable electronic devices with device advisories have the potential of device malfunction. Remote monitoring (RM) of devices has been suggested to allow the identification of abnormal device performance and permit early intervention. We sought to describe the outcomes of patients with and without RM in devices subject to the Abbott Premature Battery Depletion (PBD) advisory with data from a Canadian registry. Methods and results Patients with an Abbott device subject to the PBD advisory from nine implantable cardioverter defibrillator (ICD) implanting centres in Canada were included in the registry. The use of RM was identified from baseline and follow-up data in the registry. The primary outcome was detection of PBD and all-cause mortality. A total of 2666 patients were identified with a device subject to the advisory. In all, 1687 patients (63.2%) had RM at baseline. There were 487 deaths during follow-up. At a mean follow-up of 5.7 ± 0.7 years, mortality was higher in those without a remote monitor compared with RM at baseline (24.7% vs. 14.5%; P &lt; 0.001). Pre-mature battery depletion was identified in 36 patients (2.1%) with RM vs. 7 (0.7%) without RM (P = 0.004). Time to battery replacement was significantly reduced in patients on RM (median 5 vs. 13 days, P = 0.001). Conclusion The use of RM in patients with ICD and cardiac resynchronization therapy under advisory improved detection of PBD, time to device replacement, and was associated with a reduction in all-cause mortality. The factors influencing the association with mortality are unknown and deserve further study.

Abstract 16099: Predictors of Cardiovascular Implantable Electronic Device-dependence at Long-term Follow-up After Alcohol Septal Ablation in Hypertrophic Cardiomyopathy Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Weeranun D Bode ◽  
Michael F Bode ◽  
Megan Zhao ◽  
Rahul Sakhuja ◽  
Michael A Fifer ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Electronic Device ◽  
Av Block ◽  
Ventricular Pacing ◽  
Alcohol Septal Ablation ◽  
Long Term Follow Up ◽  
Baseline Characteristics ◽  
Cardiovascular Implantable Electronic Device

Introduction: The most common complication of alcohol septal ablation (ASA) is periprocedural high grade AV block (HGAVB). No long-term follow-up of cardiovascular implantable electronic device (CIED) utilization after ASA has been reported. Hypothesis: Pacemaker dependence on long-term follow up can be predicted by ECG or procedural characteristics. Methods: We analyzed all patients with hypertrophic cardiomyopathy who underwent ASA from December 1998 to December 2019 at our institution and received their first CIED within 30 days after ASA for HGAVB. All available follow-up interrogations were reviewed. CIED dependence was defined as ventricular pacing of ≥5%. CIED programming was determined by the patients’ cardiologists' discretion. Results: A total of 103 patients with hypertrophic cardiomyopathy underwent ASA. The average follow up duration was 10.1 years. Within 30 days after ASA, a total 25 patients received a CIED for HGAVB. On long term follow-up 16 patients (64%) were found to be CIED-dependent. Baseline characteristics, including pre and post-ASA ECG, were not significantly different between dependent and non-dependent patients (Table). The only predictor for CIED dependence was >1 ml of alcohol injected during ASA (OR 6.0, p<0.046). Conclusions: CIED implantation after ASA is common. Almost two thirds of patients who received CIED for postprocedural HGAVB were CIED-dependent on long term follow up. CIED dependence can be predicted by amount of injected alcohol >1 ml during ASA.

P3628Contemporary coronary artery disease prevalence in a valvular heart disease population undergoing surgery

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T J Carvalho Mendonca ◽  
C Strong ◽  
D Roque ◽  
L Morais ◽  
J P Reis ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Treatment Strategies ◽  
Disease Prevalence ◽  
Valve Surgery ◽  
Heart Valve Surgery ◽  
Left Main ◽  
All Cause Mortality ◽  
Baseline Characteristics ◽  
Artery Disease

Abstract Background Patients undergoing heart valve surgery are routinely evaluated for the presence of Coronary Artery Disease (CAD), with the standard practice of combining valve intervention with a revascularization procedure, notably Coronary Artery Bypass Graft (CABG). Older studies suggest rates as high as 50% prevalence of CAD in this population. However, CAD prevalence, its treatment and prognostic implication has been questioned recently. Objectives The goal of this study is to evaluate the baseline characteristics, prevalence of CAD and treatment strategies in a contemporary population with valvular heart disease (VHD) referred for valve surgery. Methods In a national multicentre registry, consecutive patients, from Jan 2015 to Dec 2016, with a formal indication for heart valve surgery referred for a pre-op routine coronary angiogram were systematically analysed. Baseline characteristics, valve pathology and CAD prevalence and patterns were determined. Obstructive CAD was defined as luminal angiographic stenosis ≥70% (≥50% for left main artery). The prognostic impact of the different valve disease and CAD treatment strategies were assessed. Results 1175 patients (mean age 72.5±10.1; male 49.2%) fulfilled the clinical or echocardiographic indication for valve surgery by European guidelines. Valvular disease prevalence was: aortic stenosis (66.7%), aortic regurgitation (6.6%), mitral stenosis (6%), mitral regurgitation (19.2%), tricuspid regurgitation (7.5%). Mean follow-up time was 29.06±18.46 months. Prevalence of comorbidities was: Diabetes Mellitus (DM) 26%, chronic obstructive pulmonary disease (COPD) 5.7% and chronic kidney disease (CKD) 23.4%. Mean Euroscore II was 2.6%. Obstructive CAD was present in 27.3% patients. Mean Syntax score was 10.2 (<22 in 88%, 23–32 in 10.2% and >33 in 1.8%). Left main artery and 3-vessel disease were found in 13.1% and 11.8% of patients with CAD, respectively. Valvular surgery was ultimately performed in 80.3%. In patients with CAD, 57.3% were revascularized. All-cause mortality rate during follow-up was 12.9%, with 7.8% from cardiovascular causes. In univariate analysis DM, COPD, CKD, NYHA class, obstructive CAD and no surgery (p<0.05) were associate with mortality on follow up. In multivariate analysis obstructive CAD (OR 2.36, 95% CI 1.53–3.65, p<0.01) and no surgery (OR 6.05, 95% CI 3.95–9.30, p<0.01) persisted as independent all-cause mortality predictors. Conclusion In a contemporary cohort of patients with VHD and surgical indication, CAD prevalence is lower (27.3%) than described in literature. Mortality rates were higher in patients with obstructive CAD, worse NYHA functional class and in those who never underwent surgery.

scholarly journals Practices of cardiac implantable electronic device follow-up: results of the European Heart Rhythm Association survey

EP Europace ◽  
2012 ◽  
Vol 14 (3) ◽  
pp. 423-425 ◽  
Author(s):  
G. Marinskis ◽  
L. van Erven ◽  
M. G. Bongiorni ◽  
G. Y. H. Lip ◽  
L. Pison ◽  
...  
Keyword(s):  
Electronic Device ◽  
Heart Rhythm ◽  
Cardiac Implantable Electronic Device

scholarly journals Impact of female sex in transcatheter aortic valve replacement. Long-term outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Gambo Ruberte ◽  
B Peiro Aventin ◽  
T Simon Paracuellos ◽  
D Gomez Martin ◽  
A Perez Guerrero ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Long Term Outcomes ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Baseline Characteristics

Abstract Introduction Women comprise ≥50% patients undergoing transcatheter aortic valve replacement (TAVR). Women have different baseline clinical characteristics and some studies have suggested that TAVR procedure carries better results and prognosis. Purpose Evaluate gender differences in baseline characteristics and long-term outcomes in patients with aortic stenosis undergoing TAVR. Methods A cohort study was conducted. Consecutive patients underwent TAVR from January 2012 to December 2020 were included. Clinical and follow-up characteristics were recorded. MACE (major adverse cardiovascular events including all-cause mortality, myocardial infarction, cerebrovascular accident and heart failure hospitalization) as primary outcome was searched. Results A total of 292 consecutive patients were included. 48.95% were women and median age was 81.07 years (77.73–86.22). 77% TAVR patients received self-expanding prosthesis. Compared with men, women were significantly older and had lower glomerular filtration rate but a lower prevalence of comorbid conditions, such as atrial fibrillation (AF), coronary and peripheral arterial disease (PAD) and cerebrovascular disease. Left ventricular ejection fraction (LVEF) was higher in women. Global baseline characteristics and events at follow-up are summarized in figure 1. At a median follow up of 21.30 (8.52–38.94) months, MACE were lower in women (Odds ratio [OR] 0.60 95% CI: 0.36–1.00). Additionally, women showed lower rates of heart failure hospitalizations (OR 0.34 95% CI 0.16–0.70). There were no statistically significant differences in all-cause mortality. Survival curves for the endpoint of heart failure hospitalizations are represented in figure 2, showing a significant difference between men and women, and demonstrating that the latter present fewer events during follow-up (HR 0.42 95% CI 0.21–0.83). Conclusion In our study, female TAVR recipients had better outcomes than men. The possible reasons for this female-sex-related benefit could be due to better LVEF and fewer comorbidities. Understanding the reasons why men have worse prognostic post-TAVR is essential for guarantee appropriate treatment selection, as well as for achieving the best possible long-term and safety outcomes. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals Thirty-Day Readmission Rates After Takotsubo Syndrome With or Without Malignancy: A Nationwide Readmissions Database Analysis

2020 ◽  
Author(s):  
Sun-Joo Jang ◽  
Ilhwan Yeo ◽  
Chanel Jonas ◽  
Parag Goyal ◽  
Jim W. Cheung ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Readmission Rate ◽  
Takotsubo Syndrome ◽  
Database Analysis ◽  
Readmission Rates ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Baseline Characteristics

Abstract Background: Association of malignancy with readmission after TTS hospitalization has not been fully described. We sought to examine the rates, cause and cost of 30-day readmissions and 30-day all-cause mortality of Takotsubo syndrome (TTS) patients with or without malignancy. Methods: The Nationwide Readmissions Databases from 2010 to 2014 were queried to identify and compare baseline characteristics and outcomes of patients hospitalized for TTS with and without malignancy. Results: We identified 61,588 index hospitalizations for TTS. TTS patients with malignancy were older (70.6 ± 0.2 vs. 66.1 ± 0.1, p < 0.001), and the overall burden of comorbidities was higher than in those without malignancy. TTS patients with malignancy had significantly higher 30-day readmission rates than those without malignancy (15.9% vs. 11.0%; odds ratio [OR], 1.35; 95% confidence interval [CI], 1.18 - 1.56). Majority (75.5%) of the etiologies for readmissions were non-cardiac, with infection being most common (20.1%). The 30-day readmission rate due to the recurrent TTS was similar in both groups (0.4% and 0.5%, respectively; p = 0.47). Importantly, 30-day all-cause mortality was higher in TTS with vs. without malignancy (4.8% vs 2.5%; OR, 1.62; 95% CI, 1.25 - 2.10). The total costs (index admission + readmission) were higher by 25% (p < 0.001) in TTS patients with malignancy vs. without malignancy. Conclusions: In patients hospitalized with TTS, the presence of malignancy was associated with increased risk of 30-day readmission, mostly attributable to non-cardiac etiologies. Importantly, the 30-day all-cause mortality and cost were also significantly higher. These findings highlight the importance of optimization of treatment and follow up in patients with malignancy after hospitalizations for TTS.

P6546Canadian Registry of Electronic Device Outcomes (CREDO): remote monitoring outcomes in the abbott battery performance alert, a multicentre cohort

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Davis ◽  
B Thibault ◽  
I Mangat ◽  
B Coutu ◽  
M Bennett ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Primary Outcome ◽  
Electronic Device ◽  
Electronic Devices ◽  
Device Performance ◽  
Remote Monitor ◽  
Cardiac Implantable Electronic Devices ◽  
All Cause Mortality ◽  
Multicentre Cohort

Abstract Background Cardiac implantable electronic devices have been known to have lead and device malfunctions leading to advisories. Increased use of remote monitoring of devices has been suggested to allow the identification of abnormal device performance and allow early intervention. We sought to describe the outcomes of patients with and without remote monitoring of in devices in the Abbott Premature Battery Depletion advisory with data from a Canadian registry Methods Patients with an Abbott device subject to the Battery Performance Alert Advisory from nine ICD implanting centres in Canada were included in the registry. The use of remote monitoring was identified from baseline and followup data in the registry. The primary outcome was detection of premature battery depletion and all cause mortality. Results 2679 patents were identified with a device subject to the advisory. Devices were implanted between 2010 and 2017. 1716 patients (64%) had remote monitoring at baseline with this increasing to 83.7% at followup at 12 months. Premature battery depletion occurred in 43 patients (1.6%). Discovery of premature battery depletion was detected by remote monitoring in 70% of patients. There were 492 deaths during the follow up. Mortality was higher in those without a remote monitor compared to those with a remote monitor at follow-up and remote monitor at baseline and follow-up (11.3%, 2.6% versus 6.1% respectively; p=0.0186). There were no deaths attributed to premature battery depletion Conclusion The use of remote monitoring in patients with ICD and CRT under advisory reliably detected device failure and was associated with a reduction in all-cause mortality.

Abstract P105: Women with Atrial Fibrillation have Increased Risk of Incident Stroke: Insights from a Propensity-Matched Study of the AFFIRM Trial

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Brita Roy ◽  
Ravi V Desai ◽  
Mustafa I Ahmed ◽  
Gregg C Fonarow ◽  
Wilbert S Anorow ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Propensity Scores ◽  
Cox Regression ◽  
Men And Women ◽  
Female Sex ◽  
Increased Risk ◽  
Comorbidity Burden ◽  
All Cause Mortality ◽  
Baseline Characteristics

Background: Women with atrial fibrillation (AF) have been reported to have poor outcomes. It remains unclear if this association is intrinsic or mediated by the higher comorbidity burden of female AF patients. Therefore, we examined the association between sex and outcomes in a balanced cohort of propensity-matched AF patients who participated in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial. Methods: Of the 4060 AFFIRM patients, 1594 (39%) were women. Propensity scores for female sex were calculated for each of the 4060 patients, and were used to assemble a cohort of 1097 pairs of men and women who were balanced on 51 baseline characteristics, including major cardiovascular (CV) risk factors and medication use, including warfarin. Matched Cox regression models were used to estimate the association between female sex and outcomes during 6 years of follow-up. Results: Patients (n=4060) had a mean (±SD) age of 70 (±8) years and 13% were African American. All-cause mortality occurred in 19% and 15% of matched men and women, respectively (matched HR when women were compared to men, 0.88; 95% CI, 0.69-1.11; p=0.279). All-cause hospitalization occurred in 61% of both men and women (matched HR for women, 1.06; 95% CI, 0.93-1.21; p=0.372). Sex was not associated with CV hospitalization (matched HR for women, 1.13; 95% CI, 0.97-1.32; p=0.111). Ischemic stroke occurred in 3% and 5% of matched men and women, respectively (OR when women were compared to men, 2.02; 95% CI, 1.28-3.18; p=0.002). There was no sex-related difference in major bleeding (7% each). Conclusion: In a cohort of AF patient in which men and women were well-balanced on 51 baseline characteristics including warfarin use, women had increased risk of stroke, but there was no sex-related variation in all-cause mortality or CV hospitalization.

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