Discharge Prescription of Angiotensin II Receptor Blockers and All-Cause Mortality in Hospitalized Medicare Beneficiaries with Heart Failure and Preserved Ejection Fraction: A Propensity-Matched Study of the OPTIMIZE-HF

2011 ◽  
Vol 17 (8) ◽  
pp. S64
Author(s):  
Ali Ahmed ◽  
Yan Zhang ◽  
Marjan Mujib ◽  
Pushkar P. Pawar ◽  
Tarun Arora ◽  
...  
Keyword(s):  
Heart Failure ◽  
Angiotensin Ii ◽  
Ejection Fraction ◽  
Preserved Ejection Fraction ◽  
Medicare Beneficiaries ◽  
Angiotensin Ii Receptor ◽  
All Cause Mortality ◽  
Receptor Blockers ◽  
Matched Study ◽  
Discharge Prescription

Abstract 19094: Use of ACE Inhibitors or Angiotensin Receptor Blockers is Associated With a Significantly Lower Risk of 30-day All-cause and Heart Failure Readmissions and All-cause Mortality in Older Medicare Beneficiaries Hospitalized for Heart Failure Developing Acute Kidney Injury

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mohammed Siddiqui ◽  
Paul W Sanders ◽  
Garima Arora ◽  
Charity Morgan ◽  
Sijian Zhang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Angiotensin Receptor ◽  
Medicare Beneficiaries ◽  
All Cause Mortality ◽  
Receptor Blockers ◽  
Discharge Prescription

Background: We presented data that demonstrating that acute kidney injury (AKI) as defined by a rise in admission serum creatinine by ≥0.3mg/dL is associated with a 16% significant increase in 30-day all-cause readmission in hospitalized heart failure (HF) patients (Circulation. 2014; 130: A19999). We have previously published data suggesting that the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) is associated with improved outcomes in HF patients with chronic kidney disease (PMC3324926 and PMC3575519). However, these drugs are often avoided in HF patients with AKI. Methods: Of the 8049 Medicare beneficiaries hospitalized for HF and discharged alive from 106 U.S. hospitals (1998-2001), 6854 had data on admission, discharge, and highest serum creatinine, of which 2180 had AKI (a rise in admission serum creatinine by ≥0.3 mg/dL) and of these 1171 (54%) received a discharge prescription for ACEIs or ARBs. Using propensity scores for ACEI or ARB use, we assembled a matched cohort of 755 pairs of patients balanced on 33 baseline characteristics including baseline serum creatinine and rise of serum creatinine. Results: 30-day all-cause readmission occurred in 21% and 27% of matched patients receiving and not receiving ACEIs or ARBs, respectively (HR, 0.77; 95% CI, 0.62-0.95; p=0.015). 30-day HF readmission occurred in 6% and 11% of matched patients receiving and not receiving ACEIs or ARBs, respectively (HR, 0.53; 95% CI, 0.37-0.76; p=0.001). 30-day all-cause mortality occurred in 5% and 9% of matched patients receiving and not receiving ACEIs or ARBs, respectively (HR, 0.89; 95% CI, 0.79-1.00; p=0.052). Both readmission and mortality benefits persisted for 12 months post-discharge (Figure). Conclusions: Among patients hospitalized for HF who developed AKI after hospital admission, discharge prescription of ACEIs or ARBs was associated with significant short- and long-term improvements in outcomes.

Long-term systolic blood pressure and all-cause mortality in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Huang ◽  
C Liu
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Funding Source ◽  
Preserved Ejection Fraction ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
History Of

Abstract Background Lower systolic blood pressure (SBP) at admission or discharge was associated with poor outcomes in patients with heart failure and preserved ejection fraction (HFpEF). However, the optimal long-term SBP for HFpEF was less clear. Purpose To examine the association of long-term SBP and all-cause mortality among patients with HFpEF. Methods We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study. Participants had at least two SBP measurements of different times during the follow-up were included. Long-term SBP was defined as the average of all SBP measurements during the follow-up. We stratified participants into four groups according to long-term SBP: <120mmHg, ≥120mmHg and <130mmHg, ≥130mmHg and <140mmHg, ≥140mmHg. Multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality associated with SBP level. To assess for nonlinearity, we fitted restricted cubic spline models of long-term SBP. Sensitivity analyses were conducted by confining participants with history of hypertension or those with left ventricular ejection fraction≥50%. Results The 3338 participants had a mean (SD) age of 68.5 (9.6) years; 51.4% were women, and 89.3% were White. The median long-term SBP was 127.3 mmHg (IQR 121–134.2, range 77–180.7). Patients in the SBP of <120mmHg group were older age, less often female, less often current smoker, had higher estimated glomerular filtration rate, less often had history of hypertension, and more often had chronic obstructive pulmonary disease and atrial fibrillation. After multivariable adjustment, long-term SBP of 120–130mmHg and 130–140mmHg was associated with a lower risk of mortality during a mean follow-up of 3.3 years (HR 0.65, 95% CI: 0.49–0.85, P=0.001; HR 0.66, 95% CI 0.50–0.88, P=0.004, respectively); long-term SBP of <120mmHg had similar risk of mortality (HR 1.03, 95% CI: 0.78–1.36, P=0.836), compared with long-term SBP of ≥140mmHg. Findings from restricted cubic spline analysis demonstrate that there was J-shaped association between long-term SBP and all-cause mortality (P=0.02). These association was essentially unchanged in sensitivity analysis. Conclusions Among patients with HFpEF, long-term SBP showed a J-shaped pattern with all-cause mortality and a range of 120–140 mmHg was significantly associated with better outcomes. Future randomized controlled trials need to evaluate optimal long-term SBP goal in patients with HFpEF. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): China Postdoctoral Science Foundation Grant (2019M660229 and 2019TQ0380)

scholarly journals Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pankaj Garg ◽  
Hosamadin Assadi ◽  
Rachel Jones ◽  
Wei Bin Chan ◽  
Peter Metherall ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
T1 Mapping ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Native T1 ◽  
Lv Mass ◽  
All Cause Mortality ◽  
Ventricular Fibrosis

AbstractCardiac magnetic resonance (CMR) is emerging as an important tool in the assessment of heart failure with preserved ejection fraction (HFpEF). This study sought to investigate the prognostic value of multiparametric CMR, including left and right heart volumetric assessment, native T1-mapping and LGE in HFpEF. In this retrospective study, we identified patients with HFpEF who have undergone CMR. CMR protocol included: cines, native T1-mapping and late gadolinium enhancement (LGE). The mean follow-up period was 3.2 ± 2.4 years. We identified 86 patients with HFpEF who had CMR. Of the 86 patients (85% hypertensive; 61% males; 14% cardiac amyloidosis), 27 (31%) patients died during the follow up period. From all the CMR metrics, LV mass (area under curve [AUC] 0.66, SE 0.07, 95% CI 0.54–0.76, p = 0.02), LGE fibrosis (AUC 0.59, SE 0.15, 95% CI 0.41–0.75, p = 0.03) and native T1-values (AUC 0.76, SE 0.09, 95% CI 0.58–0.88, p < 0.01) were the strongest predictors of all-cause mortality. The optimum thresholds for these were: LV mass > 133.24 g (hazard ratio [HR] 1.58, 95% CI 1.1–2.2, p < 0.01); LGE-fibrosis > 34.86% (HR 1.77, 95% CI 1.1–2.8, p = 0.01) and native T1 > 1056.42 ms (HR 2.36, 95% CI 0.9–6.4, p = 0.07). In multivariate cox regression, CMR score model comprising these three variables independently predicted mortality in HFpEF when compared to NTproBNP (HR 4 vs HR 1.65). In non-amyloid HFpEF cases, only native T1 > 1056.42 ms demonstrated higher mortality (AUC 0.833, p < 0.01). In patients with HFpEF, multiparametric CMR aids prognostication. Our results show that left ventricular fibrosis and hypertrophy quantified by CMR are associated with all-cause mortality in patients with HFpEF.

scholarly journals Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Kentaro Kamiya ◽  
Yukihito Sato ◽  
Tetsuya Takahashi ◽  
Miyuki Tsuchihashi-Makaya ◽  
Norihiko Kotooka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Preserved Ejection Fraction ◽  
Composite Outcome ◽  
Term Survival ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Related Quality

Background: Exercise-based cardiac rehabilitation (CR) improves health-related quality of life and exercise capacity in patients with heart failure (HF). However, CR efficacy in patients with HF who are elderly, frail, or have HF with preserved ejection fraction remains unclear. We examined whether participation in multidisciplinary outpatient CR is associated with long-term survival and rehospitalization in patients with HF, with subgroup analysis by age, sex, comorbidities, frailty, and HF with preserved ejection fraction. Methods: This multicenter retrospective cohort study was performed in patients hospitalized for acute HF at 15 hospitals in Japan, 2007 to 2016. The primary outcome (composite of all-cause mortality and HF rehospitalization after discharge) and secondary outcomes (all-cause mortality and HF rehospitalization) were analyzed in outpatient CR program participants versus nonparticipants. Results: Of the 3277 patients, 26% (862) participated in outpatient CR. After propensity matching for potential confounders, 1592 patients were included (n=796 pairs), of which 511 had composite outcomes (223 [14%] all-cause deaths and 392 [25%] HF rehospitalizations, median 2.4-year follow-up). Hazard ratios associated with CR participation were 0.77 (95% CI, 0.65–0.92) for composite outcome, 0.67 (95% CI, 0.51–0.87) for all-cause mortality, and 0.82 (95% CI, 0.67–0.99) for HF-related rehospitalization. CR participation was also associated with numerically lower rates of composite outcome in patients with HF with preserved ejection fraction or frail patients. Conclusions: Outpatient CR participation was associated with substantial prognostic benefit in a large HF cohort regardless of age, sex, comorbidities, frailty, and HF with preserved ejection fraction.

Right ventricular diameter predicts all-cause mortality in heart failure with preserved ejection fraction

2019 ◽  
Vol 14 (7) ◽  
pp. 1091-1100 ◽  
Author(s):  
Gaspare Parrinello ◽  
Daniele Torres ◽  
Silvio Buscemi ◽  
Tiziana Di Chiara ◽  
Francesco Cuttitta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Preserved Ejection Fraction ◽  
All Cause Mortality

Abstract 16170: Impact of Anemia on Outcomes in Patients With Heart Failure With Preserved Ejection Fraction: A Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Monil Majmundar ◽  
Ashish Kumar ◽  
Rajkumar P Doshi ◽  
Palak shah ◽  
Mariam Shariff ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Publication Bias ◽  
Meta Analysis ◽  
Final Analysis ◽  
Study Data ◽  
Curve Analysis ◽  
Secondary Outcome ◽  
Preserved Ejection Fraction ◽  
All Cause Mortality

Introduction: The effect of anemia on outcomes in Heart failure with preserved ejection fraction (HFpEF) patients is not well-established. Some previous studies have shown increased mortality and hospitalizations in HFpEF patients with anemia. Hypothesis: We hypothesize that anemia affects all-cause mortality and hospitalization in HFpEF patients. Methods: A review of literature for studies comparing outcomes in HFpEF with and without anemia was done in PubMed, MEDLINE, and EMBASE databases through June 1st, 2020. The standard definitions of HFpEF and anemia were used for inclusion criteria. Two investigators extracted the study data independently. The primary outcome of interest was all-cause mortality. The secondary outcome was all-cause hospitalizations. We used the PM estimator of Tau with Knapp-Hartung adjustment to pool adjusted hazard ratio (HR) and 95% confidence interval (CI). P curve analysis was used to assess publication bias. R version 3.6.2 was used for all statistical analyses. Results: Seven studies (23,424 patients) were included in the final analysis. Anemia in patients with HFpEF was associated with higher rates of all-cause mortality [HR: 1.35, 95% CI: 1.17-1.55]. Additionally, anemia in HFpEF patients was associated with higher rates of all-cause hospitalization [HR: 1.22, 95% CI: 1.03-1.44]. P curve analysis for all-cause mortality didn’t report publication bias or P hacking (Figure) . Conclusions: Anemia in HFpEF patients was associated with higher rates of all-cause mortality and all-cause hospitalizations compared to HFpEF patients without anemia.

Angiotensin II Receptor Blockers for the Treatment of Heart Failure: A Class Effect?

2007 ◽  
Vol 27 (4) ◽  
pp. 526-534 ◽  
Author(s):  
Marie Hudson ◽  
Karin Humphries ◽  
Jack V Tu ◽  
Hassan Behlouli ◽  
Richard Sheppard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Angiotensin Ii ◽  
Angiotensin Ii Receptor Blockers ◽  
Class Effect ◽  
Angiotensin Ii Receptor ◽  
Receptor Blockers
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