Effects of iron therapy in iron deficient patients with heart failure and peripheral artery disease

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf the GeroCovid Investigators Introduction. Atrial fibrillation (AF) is the most frequent arrhythmia diagnosed in elderly patients. It often associates with disabling complications, such as stroke and systemic embolism. COVID-19 severely affects older subjects, who show a particularly high mortality, often related to relevant alterations in coagulation and inflammation cascade. Purpose. Aim of this study was to evaluate how the presence of a prevalent form of AF (at admission or in clinical history) influenced the clinical course of COVID-19 in an aged in-hospital population. Methods. We studied the acute patients included in GeroCovid, a multicenter retrospective-prospective registry designed by the Italian Society of Gerontology and Geriatric Medicine and the Norwegian Geriatrics Society. GeroCovid, independently of the healthcare setting and without exclusion criteria, enrolled subjects aged >60 years to analyze risk factors, signs, symptoms and outcomes of COVID-19 in older people. For the purpose of this study, only the acute, in-hospital, cohort was evaluated. Results. Between March 1st and June 6th 2020, 2474 patients were enrolled in GeroCovid. Of these, 806 (32.6%) were assisted in hospital, for an acute condition (age: 79 ± 9 years; men: 51.7%). The prevalence of AF was 21.8%. Patients with the arrhythmia were older (82 ± 8 vs. 77 ± 9 years; p < 0.001) and with a higher CHA2DS2-VASc score (4.1 ± 1.5 vs. 3.2 ± 1.5; p < 0.001). The prevalence of almost all comorbidities was higher in AF patients (in particular, hypertension, cardiac diseases, diabetes, heart failure, peripheral artery disease, chronic renal failure, COPD, stroke, obesity). At multivariable analysis, advanced age (p = 0.010), an increased number of white blood cells (p = 0.031), the presence of cardiac diseases (p < 0.001), peripheral artery disease (p = 0.030) and of signs or symptoms of heart failure (p = 0.003) characterized older patients with AF. In-hospital mortality was significantly higher in patients with the arrhythmia (36.9 vs. 27.5%; OR = 1.55, 95%CI = 1.09-2.20; p = 0.015). A multivariable logistic regression model showed that AF was an independent predictor of mortality (p = 0.021), such as male gender (p = 0.014) and the presence of peripheral artery disease (p = 0.003). COPD, stroke, chronic renal failure, diabetes and obesity were deleted from the final model. Conclusions. AF is frequently observed in older patients with COVID-19. Subjects with both conditions have a more complex clinical status and show a higher in-hospital mortality, thus requesting a particularly careful and intensive management.

Download Full-text

Peripheral artery disease and outcomes in patients with acute myocardial infarction

Open Heart ◽

10.1136/openhrt-2018-001004 ◽

2019 ◽

Vol 6 (1) ◽

pp. e001004 ◽

Cited By ~ 3

Author(s):

Rubina Attar ◽

Axel Wester ◽

Sasha Koul ◽

Svend Eggert ◽

Pontus Andell

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

Real Life ◽

Clinical Event ◽

High Risk Population ◽

Peripheral Artery ◽

St Elevation ◽

Artery Disease

AimTo describe the population of patients with previously diagnosed peripheral artery disease (PAD) experiencing a myocardial infarction (MI) and to investigate 1-year major adverse cardiac events (MACE: all-cause mortality, reinfarction, stroke and heart failure hospitalisation) following MI.BackgroundMI patients with PAD constitute a high-risk population with adverse cardiac outcomes. Contemporary real-life data regarding the clinical characteristics of this patient population and clinical event rates following MI remain scarce.MethodsThis observational study included all MI patients presenting with ST-elevation MI or non-ST-elevation MI between 01 January 2005 and 31 December 2014 with (n=4213) and without (n=106 763) a concurrent PAD diagnosis, identified in the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry and the National Patient Registry (PAD prevalence: 3.8%). Cox proportional hazard models were applied to compare the outcome between the two populations.ResultsMI patients with PAD were older and more often burdened with comorbidities, such as diabetes, hypertension and previous MI. After adjustments, PAD was significantly associated with higher rates of MACE (HR 1.35, 95% CI 1.27 to 1.44), mortality (HR 1.59, 95% CI 1.43 to 1.76), reinfarction (HR 1.48, 95% CI 1.32 to 1.66), stroke (HR 1.27, 95% CI 1.05 to 1.53), heart failure (HR 1.29, 95% CI 1.20 to 1.40) and bleeding (HR 1.26, 95% CI 1.09 to 1.47) at 1 year.ConclusionA concurrent PAD diagnosis was independently significantly associated with higher rates of adverse outcomes following MI in a nationwide real-life MI population. The low prevalence of PAD compared with previous studies suggests significant underdiagnosing. Future studies should investigate if PAD screening with ankle–brachial index may increase diagnosing and subsequently lead to improved treatment of polyvascular disease

Download Full-text

Peripheral artery disease and risk of adverse outcomes in heart failure with preserved ejection fraction

Clinical Cardiology ◽

10.1002/clc.22716 ◽

2017 ◽

Vol 40 (9) ◽

pp. 692-696 ◽

Cited By ~ 4

Author(s):

Pratik B. Sandesara ◽

Muhammad Hammadah ◽

Ayman Samman‐Tahhan ◽

Heval M. Kelli ◽

Wesley T. O'Neal

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Peripheral Artery Disease ◽

Adverse Outcomes ◽

Preserved Ejection Fraction ◽

Peripheral Artery ◽

Artery Disease

Download Full-text

Cardiorenal and other diabetes related outcomes with SGLT-2 inhibitors compared to GLP-1 receptor agonists in type 2 diabetes: nationwide observational study

Cardiovascular Diabetology ◽

10.1186/s12933-021-01258-x ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Moa Lugner ◽

Naveed Sattar ◽

Mervete Miftaraj ◽

Jan Ekelund ◽

Stefan Franzén ◽

...

Keyword(s):

Heart Failure ◽

Type 2 Diabetes ◽

Observational Study ◽

Peripheral Artery Disease ◽

Peripheral Artery ◽

Short Term Treatment ◽

Receptor Agonists ◽

Artery Disease ◽

Nationwide Observational Study

Abstract Background Major prospective randomized clinical safety trials have demonstrated beneficial effects of treatment with glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium–glucose co-transporter-2 inhibitors (SGLT-2i) in people with type 2 diabetes and elevated cardiovascular risk, and recent clinical treatment guidelines therefore promote early use of these classes of pharmacological agents. In this Swedish nationwide observational study, we compared cardiorenal outcomes and safety of new treatment with GLP-1RA and SGLT-2i in people with type 2 diabetes. Methods We linked data from national Swedish databases to capture patient characteristics and outcomes and used propensity-score based matching to account for differences between the two groups. The treatments were compared using Cox regression models. Results We identified 9648 participants starting GLP-1RA and 12,097 starting SGLT-2i with median follow-up times 1.7 and 1.1 years, respectively. The proportion of patients with a history of MACE were 15.8%, and 17.0% in patients treated with GLP-1RA and SGLT-2i, respectively. The mean age was 61 years with 7.6 years duration of diabetes. Mean HbA1c were 8.3% (67.6 mmol/mol) and 8.3% (67.2 mmol/mol), and mean BMI 33.3 and 32.5 kg/m2 in patients treated with GLP-1RA or SGLT-2i, respectively. The cumulative mortality risk was non-significantly lower in the group treated with SGLT-2i, HR 0.78 (95% CI 0.61–1.01), as were incident heart failure outcomes, but the risks of cardiovascular or renal outcomes did not differ. The risks of stroke and peripheral artery disease were higher in the SGLT-2i group relative to GLP-1RA, with HR 1.44 (95% CI 0.99–2.08) and 1.68 (95% CI 1.04–2.72), respectively. Conclusions This observational study suggests that treatment with GLP-1RA and SGLT-2i result in very similar cardiorenal outcomes. In the short term, treatment with GLP-1RA seem to be associated with lower risks of stroke and peripheral artery disease, whereas SGLT-2i seem to be nominally associated with lower risk of heart failure and total mortality.

Download Full-text

Association of Heart Failure With Outcomes Among Patients With Peripheral Artery Disease: Insights From EUCLID

Journal of the American Heart Association ◽

10.1161/jaha.120.018684 ◽

2021 ◽

Author(s):

Marc D. Samsky ◽

Anne Hellkamp ◽

William R. Hiatt ◽

F. Gerry R. Fowkes ◽

Iris Baumgartner ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Peripheral Artery Disease ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

Peripheral Artery ◽

Factors Associated ◽

Artery Disease

Background Peripheral artery disease (PAD) and heart failure (HF) are each independently associated with poor outcomes. Risk factors associated with new‐onset HF in patients with primary PAD are unknown. Furthermore, how the presence of HF is associated with outcomes in patients with PAD is unknown. Methods and Results This analysis examined risk relationships of HF on outcomes in patients with symptomatic PAD randomized to ticagrelor or clopidogrel as part of the EUCLID (Examining Use of Ticagrelor in Peripheral Arterial Disease) trial. Patients were stratified based on presence of HF at enrollment. Cox models were used to determine the association of HF with outcomes. A separate Cox model was used to identify risk factors associated with development of HF during follow‐up. Patients with PAD and HF had over twice the rate of concomitant coronary artery disease as those without HF. Patients with PAD and HF had significantly increased risk of major adverse cardiovascular events (hazard ratio [HR], 1.31; 95% CI, 1.13–1.51) and all‐cause mortality (HR, 1.39; 95% CI, 1.19–1.63). In patients with PAD, the presence of HF was associated with significantly less bleeding (HR, 0.65; 95% CI, 0.45–0.96). Characteristics associated with HF development included age ≥66 (HR, 1.29; 95% CI, 1.18–1.40 per 5 years), diabetes mellitus (HR, 1.85; 95% CI, 1.41–2.43), and weight (bidirectionally associated, ≥76 kg, HR, 0.77; 95% CI, 0.64–0.93; <76 kg, HR, 1.12; 95% CI, 1.07–1.16). Conclusions Patients with PAD and HF have a high rate of coronary artery disease with a high risk for major adverse cardiovascular events and death. These data support the possible need for aggressive treatment of (recurrent) atherosclerotic disease in PAD, especially patients with HF.

Download Full-text