Alcohol Consumption and Risk of Death in Male Physicians With Heart Failure

Introduction: Alcohol is a known cardiac toxin, yet the nature of the association between alcohol consumption and the development of heart failure (HF) in the community, and whether this relationship is different in men and women, is unclear. Therefore we assessed the association between alcohol intake and the development of HF or death in men and women in the Atherosclerosis Risk in Communities (ARIC) Study. Methods: We examined 14,993 participants in ARIC without prevalent HF at baseline (1987-89) who were followed through 2009 (median of 20.6 years). Self-reported alcohol consumption was defined as the number of drinks per day (1 drink=14g of alcohol). Using Cox proportional hazards models, we examined the association of alcohol intake with the composite outcome of death or hospitalization for HF, stratified by sex, adjusting for age, diabetes, hypertension, coronary heart disease, body mass index, total cholesterol, physical activity, education level, smoking status, and incident myocardial infarction as a time varying covariate. Results: The risk for HF or death in men was lowest among those who consumed 0-1 drink/day (HR 0.81, 95% CI, 0.72-0.90) compared with those who did not consume alcohol. In contrast, in women the risk associated with consuming 1 or 2 drinks/day was not significantly different from the non-drinkers (0-1 drink HR 1.03, 95% CI 0.89-1.20; 1-2 drinks, HR 1.09, 95% CI 0.81-1.46, P for interaction by sex 0.01). Drinking ≥3 drinks/day increased the risk of HF or death by 40% in men (HR 1.44, 95% CI 1.20-1.72) but more than doubled the risk in women (HR 2.44, 95% CI 1.34-4.47). Conclusion: Consumption of ≥3 alcoholic drinks/day is associated with increased risk for death/HF in both men and women, with a higher risk in women, even adjusting for body size and other covariates. Compared to alcohol abstinence, low alcohol consumption was associated with a lower risk of death/HF in men but not in women. These findings suggest that the toxic and protective effects of alcohol may be different in men and women.

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Alcohol consumption and risk of heart failure in the GISSI-PREVENZIONE Study

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(08)60055-7 ◽

2008 ◽

Vol 7 ◽

pp. 20-20

Author(s):

G LEVANTESI ◽

R MARFISI ◽

M SCARANO ◽

M SILLETTA ◽

A MAGGIONI ◽

...

Keyword(s):

Heart Failure ◽

Alcohol Consumption

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Faculty Opinions recommendation of Employment status at time of first hospitalization for heart failure is associated with a higher risk of death and rehospitalization for heart failure.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732125725.793543840 ◽

2018 ◽

Author(s):

Gad Cotter ◽

Olga Milo

Keyword(s):

Heart Failure ◽

Employment Status ◽

Risk Of Death

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Interleukin-1 receptor-induced PGE2 production controls acetylcholine-mediated cardiac dysfunction and mortality during scorpion envenomation

Nature Communications ◽

10.1038/s41467-020-19232-8 ◽

2020 ◽

Vol 11 (1) ◽

Author(s):

Mouzarllem B. Reis ◽

Fernanda L. Rodrigues ◽

Natalia Lautherbach ◽

Alexandre Kanashiro ◽

Carlos A. Sorgi ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Dysfunction ◽

Acetylcholine Release ◽

Interleukin 1 ◽

Clinical Manifestations ◽

Prostaglandin E ◽

High Dose ◽

Scorpion Envenomation ◽

Risk Of Death ◽

Include Heart Failure

Abstract Scorpion envenomation is a leading cause of morbidity and mortality among accidents caused by venomous animals. Major clinical manifestations that precede death after scorpion envenomation include heart failure and pulmonary edema. Here, we demonstrate that cardiac dysfunction and fatal outcomes caused by lethal scorpion envenomation in mice are mediated by a neuro-immune interaction linking IL-1 receptor signaling, prostaglandin E2, and acetylcholine release. IL-1R deficiency, the treatment with a high dose of dexamethasone or blockage of parasympathetic signaling using atropine or vagotomy, abolished heart failure and mortality of envenomed mice. Therefore, we propose the use of dexamethasone administration very early after envenomation, even before antiserum, to inhibit the production of inflammatory mediators and acetylcholine release, and to reduce the risk of death.

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Catheter ablation can improve survival with the reduction of heart failure in frail patients with atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0557 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

B Joung ◽

P.S Yang ◽

J.H Sung ◽

E Jang ◽

H.T Yu ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Catheter Ablation ◽

Real World ◽

Background Characteristics ◽

Risk Of Death ◽

Frail Patients ◽

Korean National Health Insurance

Abstract Background It is unclear whether catheter ablation is beneficial in frail patients with AF. Purpose This study aimed to evaluate whether catheter ablation reduces death and other outcomes in real-world frail patients with atrial fibrillation (AF). Methods Out of 801,710 patients with AF in the Korean National Health Insurance Service database from 2006 to 2015, 1,411 frail patients underwent AF ablations. The Hospital Frailty Risk Score were calculated retrospectively. Inverse probability of treatment weighting (IPTW) was used to categorize ablation and non-ablation frail groups. Results After IPTW, the two cohorts had similar background characteristics. During a median follow-up of 4.7 years (interquartile range: 2.2–7.8), the risk of death in frail patients with ablations was reduced by 65% compared to frail patients without ablations (2.0 and 6.4 per 100 person-years, respectively; hazard ratio [HR] 0.35; 95% confidence interval [CI] 0.25–0.50; P<0.001). Ablations were related with a lower incidence and risk of heart failure admission (1.8 and 3.1 per 100 person-years, respectively; HR 0.66, 95% CI 0.44–0.98; P=0.042) and acute myocardial infarction (0.2 and 0.6 per 100 person-years, respectively; HR 0.30, 95% CI 0.15–0.62; P=0.001). However, the risk of stroke did not change after ablation. Conclussion Ablation may be associated with lower incidences of death, heart failure, and acute myocardial infarction in real-world frail patients with AF, supporting the role of AF ablation in these patients. The effect of frailty risk on the outcome of ablation should be evaluated in further studies. Funding Acknowledgement Type of funding source: None

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Pulmonary Hypertension Complicating Pregnancy

Current Pulmonology Reports ◽

10.1007/s13665-021-00275-1 ◽

2021 ◽

Author(s):

Sheila Krishnan ◽

Erin M. Fricke ◽

Marcos Cordoba ◽

Laurie A. Chalifoux ◽

Reda E. Girgis

Keyword(s):

Heart Failure ◽

Pulmonary Hypertension ◽

Post Partum ◽

Severe Heart Failure ◽

Neonatal Morbidity ◽

Risk Of Death ◽

Risk Condition ◽

Pulmonary Arterial ◽

Phosphodiesterase Type ◽

Type V

Abstract Purpose of review This study aims to describe the pathophysiology of pregnancy in pulmonary hypertension (PH) and review recent literature on maternal and fetal outcomes. Recent findings There is an increasing number of pregnant women with PH. Maternal mortality in pulmonary arterial hypertension (PAH) ranges from 9 to 25%, most commonly from heart failure and arrythmias. The highest risk of death is peri-partum and post-partum. Fetal/neonatal morbidity and mortality are also substantial. There are high rates of prematurity, intrauterine growth retardation, and preeclampsia. Women should be referred to expert centers for management. Combination PAH therapy with parenteral prostacyclin and a phosphodiesterase type V inhibitor is recommended. Induced vaginal delivery is preferred, except in cases of severe heart failure or obstetric indications for cesarean section. Summary Despite advances in management, pregnancy in PAH remains a high-risk condition and should be prevented.

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Worsening Renal Function during Index Hospitalization Does Not Predict Prognosis in Heart Failure with Preserved Ejection Fraction Patients

Cardiology ◽

10.1159/000512431 ◽

2021 ◽

pp. 1-8

Author(s):

Ravi Rasalingam ◽

Rachel Parker ◽

Katherine E. Kurgansky ◽

Luc Djousse ◽

David Gagnon ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Ejection Fraction ◽

Left Ventricular ◽

Incidence Density ◽

Preserved Ejection Fraction ◽

Index Hospitalization ◽

Risk Of Death ◽

Worsening Renal Function ◽

Group 1

Introduction: Worsening renal function (WRF) predicts poor prognosis in patients with left ventricular systolic dysfunction. The effect of WRF in heart failure with preserved ejection fraction (HFpEF) is unclear. Objective: The objective of this study was to determine whether WRF during index hospitalization for HFpEF is associated with increased death or readmission for heart failure. Methods: National Veterans Affairs electronic medical data recorded between January 1, 2002, and December 31, 2014, were screened to identify index hospitalizations for HFpEF using an iterative algorithm. Patients were divided into 3 groups based on changes in serum Cr (sCr) during this admission. WRF was defined as a rise in sCr ≥0.3 mg/dL. Group 1 had no evidence of WRF, group 2 had transient WRF, and group 3 had persistent WRF at the time of discharge. Results: A total of 10,902 patients with index hospitalizations for HFpEF were identified (mean age 72, 97% male). Twenty-nine percent had WRF during this hospital admission, with 48% showing recovery of sCr and 52% with no recovery at discharge. The mortality rate over a mean follow-up duration of 3.26 years was 72%. Compared to group 1, groups 2 and 3 showed no significant difference in risk of death from any cause (hazard ratio [HR] = 0.95 [95% confidence interval [CI]: 0.87, 1.03] and 1.02 [95% CI: 0.93, 1.11], respectively), days hospitalized for any cause (incidence density ratio [IDR] = 1.01 [95% CI: 0.92, 1.11] and 1.01 [95% CI: 0.93, 1.11], respectively), or days hospitalized for heart failure (IDR = 0.94 [95% CI: 0.80, 1.10] and 0.94 [95% CI: 0.81, 1.09], respectively) in analyses adjusted for covariates affecting renal function and outcomes. Conclusions: While there is a high incidence of WRF during index hospitalizations for HFpEF, WRF is not associated with an increased risk of death or hospitalization. This suggests that WRF alone should not influence decisions regarding heart failure management.

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Comparative effectiveness of bisoprolol and carvedilol among patients receiving maintenance hemodialysis

Clinical Kidney Journal ◽

10.1093/ckj/sfaa248 ◽

2021 ◽

Author(s):

Ping-Hsun Wu ◽

Yi-Ting Lin ◽

Jia-Sin Liu ◽

Yi-Chun Tsai ◽

Mei-Chuan Kuo ◽

...

Keyword(s):

Heart Failure ◽

Ischemic Stroke ◽

Lower Risk ◽

Cox Model ◽

Major Adverse Cardiovascular Events ◽

Maintenance Hemodialysis ◽

Risk Of Death ◽

Relative Safety ◽

Dialysis Vintage ◽

All Cause Mortality

Abstract Background Despite widespread use, there is no trial evidence to inform β-blocker’s (BB) relative safety and efficacy among patients undergoing hemodialysis (HD). We herein compare health outcomes associated with carvedilol or bisoprolol use, the most commonly prescribed BBs in these patients. Methods We created a cohort study of 9305 HD patients who initiated bisoprolol and 11 171 HD patients who initiated carvedilol treatment between 2004 and 2011. We compared the risk of all-cause mortality and major adverse cardiovascular events (MACEs) between carvedilol and bisoprolol users during a 2-year follow-up. Results Bisoprolol initiators were younger, had shorter dialysis vintage, were women, had common comorbidities of hypertension and hyperlipidemia and were receiving statins and antiplatelets, but they had less heart failure and digoxin prescriptions than carvedilol initiators. During our observations, 1555 deaths and 5167 MACEs were recorded. In the multivariable-adjusted Cox model, bisoprolol initiation was associated with a lower all-cause mortality {hazard ratio [HR] 0.66 [95% confidence interval (CI) 0.60–0.73]} compared with carvedilol initiation. After accounting for the competing risk of death, bisoprolol use (versus carvedilol) was associated with a lower risk of MACEs [HR 0.85 (95% CI 0.80–0.91)] and attributed to a lower risk of heart failure [HR 0.83 (95% CI 0.77–0.91)] and ischemic stroke [HR 0.84 (95% CI 0.72–0.97)], but not to differences in the risk of acute myocardial infarction [HR 1.03 (95% CI 0.93–1.15)]. Results were confirmed in propensity score matching analyses, stratified analyses and analyses that considered prescribed dosages or censored patients discontinuing or switching BBs. Conclusions Relative to carvedilol, bisoprolol initiation by HD patients was associated with a lower 2-year risk of death and MACEs, mainly attributed to lower heart failure and ischemic stroke risk.

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